Healthcare Provider Details

I. General information

NPI: 1689890386
Provider Name (Legal Business Name): JASON B C BINNING O.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/29/2011
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: DR. JASON BC BINNING
Title or Position: OPTOMETRIC PHYSICIAN
Credential: O.D.
Phone: 561-966-3808