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1619861101 NPI number — CAITLYN ALEXIA LUBO OD

NPI Number: 1619861101
Health Care Provider/Practitioner: CAITLYN ALEXIA LUBO OD

Information about “1619861101” NPI (CAITLYN ALEXIA LUBO OD) exists in 1619861101 in HTML format HTML  |  1619861101 in plain Text format TXT  |  1619861101 in PDF (Portable Document Format) PDF  |  1619861101 in an XML format XML  formats.

NPI Number : 1619861101 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619861101",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LUBO",
    "FirstName": "CAITLYN",
    "MiddleName": "ALEXIA",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "OD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9440 POINCIANA PL APT 106",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAVIE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33324-4819",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "401-585-6168",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4413 LYONS RD STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COCONUT CREEK",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33073-4383",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-975-9181",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/07/2025",
    "LastUpdateDate": "06/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152WC0802X",
          "TaxonomyName": "Corneal and Contact Management Optometrist",
          "LicenseNumber": "6678",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WP0200X",
          "TaxonomyName": "Pediatric Optometrist",
          "LicenseNumber": "6678",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "6678",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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