Healthcare Provider Details

I. General information

NPI: 1184612822
Provider Name (Legal Business Name): JASON BC BINNING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6626 HYPOLUXO RD SUITE A4
LAKE WORTH FL
33467-7676
US

IV. Provider business mailing address

6626 HYPOLUXO RD SUITE A4
LAKE WORTH FL
33467-7676
US

V. Phone/Fax

Practice location:
  • Phone: 561-966-3808
  • Fax: 561-966-3191
Mailing address:
  • Phone: 561-966-3808
  • Fax: 561-966-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: