Healthcare Provider Details

I. General information

NPI: 1427513167
Provider Name (Legal Business Name): JASMINE MARIE BRAVO-BEAUMONT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 WAYNE AVE
CHAMBERSBURG PA
17201-2923
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 717-263-2389
  • Fax: 717-263-0884
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC005736
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003503
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: