MEDICARE: DR. STACEY CARABELLO OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	082907	IA
2	152W00000X	Optometrist	0618002996	VA

General Provider Information

NPI Number	:	1568815496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY CARABELLO OD

Provider Business Mailing Address
First Line	:	2010 BREMO RD STE 128A
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2444
Country	:	US
Telephone Number	:	877-969-0392
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 EXECUTIVE DR STE A
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2582
Country	:	US
Telephone Number	:	757-849-0565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	08/31/2023

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