Provider Demographics
NPI:1386613529
Name:MENDEZ-ORWASKY, CAROL (OD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:MENDEZ-ORWASKY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:ORWASKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:694 S. TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9216
Mailing Address - Country:US
Mailing Address - Phone:941-966-6700
Mailing Address - Fax:941-966-6839
Practice Address - Street 1:694 S. TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9216
Practice Address - Country:US
Practice Address - Phone:941-966-6700
Practice Address - Fax:941-966-6839
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078902000Medicaid
FL410019721OtherRRB MEDICARE
FL620290000Medicaid
FL650470707OtherTAX ID #
FL078902000Medicaid
FLU13810Medicare UPIN