Healthcare Provider Details

I. General information

NPI: 1174744288
Provider Name (Legal Business Name): JAZZY EYES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 S UNIVERSITY DR
DAVIE FL
33324-5828
US

IV. Provider business mailing address

2279 S UNIVERSITY DR
DAVIE FL
33324-5828
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-9823
  • Fax: 954-474-7832
Mailing address:
  • Phone: 954-474-9823
  • Fax: 954-474-7832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOE0000561
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL ALAN KIMMELMAN
Title or Position: OWNER
Credential: O.D.
Phone: 954-474-9823