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General NPI Number Information
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NPI Number | 1306389739
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Entity Type | Individual
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Provider Name | MARK CARUSO O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/03/2016
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Last Update Date | 12/03/2016
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Provider Practice Location Address
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Address Line | 7730 W COMMERCIAL BLVD
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City | SUNRISE
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State | FL
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Zip | 33351-4301
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Country | US
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Telephone | 954-578-1746
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Fax |
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Provider Business Mailing Address
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Address Line | 633 NW 28TH ST
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City | WILTON MANORS
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State | FL
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Zip | 33311-2462
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Country | US
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Telephone | 954-295-0404
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Fax |
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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 | OPC3097
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License Number State | FL
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