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General NPI Number Information
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NPI Number | 1104774439
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Entity Type | Individual
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Provider Name | LIZALBA CARABALLO LICENSE OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 1471 E OSCEOLA PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34744-1604
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Country | US
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Telephone | 407-870-9944
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Fax | 407-870-0747
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Provider Business Mailing Address
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Address Line | 1471 E OSCEOLA PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34744-1604
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Country | US
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Telephone | 407-870-9944
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Fax | 407-870-0747
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | DO7916
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License Number State | FL
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