Healthcare Provider Details

I. General information

NPI: 1811144850
Provider Name (Legal Business Name): AARON JAMES EVANS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 PLAZA REAL
BOCA RATON FL
33432-3938
US

IV. Provider business mailing address

333 PLAZA REAL
BOCA RATON FL
33432-3938
US

V. Phone/Fax

Practice location:
  • Phone: 561-392-8383
  • Fax: 561-392-1134
Mailing address:
  • Phone: 561-392-8383
  • Fax: 561-392-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: