Healthcare Provider Details

I. General information

NPI: 1164688073
Provider Name (Legal Business Name): VERONICA MARIE CARRERO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VERONICA MARIE HORMILLA O.D.

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S HIATUS RD
PEMBROKE PINES FL
33025-3617
US

IV. Provider business mailing address

1500 S HIATUS RD
PEMBROKE PINES FL
33025-3617
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-4000
  • Fax: 954-438-6000
Mailing address:
  • Phone: 954-438-4000
  • Fax: 954-438-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7310TG
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 4579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: