Healthcare Provider Details

I. General information

NPI: 1497818561
Provider Name (Legal Business Name): EDWARD LESLIE BOSHNICK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW 87TH AVE SUITE B-270
MIAMI FL
33173-3570
US

IV. Provider business mailing address

9960 SW 129 ST
MIAMI FL
33176
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-8206
  • Fax: 305-271-8209
Mailing address:
  • Phone: 305-232-2093
  • Fax: 305-233-3145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: