Healthcare Provider Details

I. General information

NPI: 1619585130
Provider Name (Legal Business Name): CAROLINE VOLLBERG MISCH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17560 US HIGHWAY 441
MOUNT DORA FL
32757-6711
US

IV. Provider business mailing address

PO BOX 201638
DALLAS TX
75320-1638
US

V. Phone/Fax

Practice location:
  • Phone: 352-744-7002
  • Fax:
Mailing address:
  • Phone: 352-744-7002
  • Fax: 352-735-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3618
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: