Healthcare Provider Details

I. General information

NPI: 1619861101
Provider Name (Legal Business Name): CAITLYN ALEXIA LUBO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 LYONS RD STE 101
COCONUT CREEK FL
33073-4383
US

IV. Provider business mailing address

9440 POINCIANA PL APT 106
DAVIE FL
33324-4819
US

V. Phone/Fax

Practice location:
  • Phone: 954-975-9181
  • Fax:
Mailing address:
  • Phone: 401-585-6168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6678
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number6678
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: