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General NPI Number Information
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NPI Number | 1114344306
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Entity Type | Organization
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Legal Business Name | BM ZOOM CORPORATION
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 9160 NW 122ND ST UNIT 28
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City | HIALEAH GARDENS
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State | FL
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Zip | 33018-1732
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Country | US
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Telephone | 305-512-4408
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Fax |
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Provider Business Mailing Address
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Address Line | 9269 NW 121ST TER
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City | HIALEAH GARDENS
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State | FL
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Zip | 33018-4224
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Country | US
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Telephone | 305-512-4408
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUBEN GONZALEZ:
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Credential |
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Telephone | 305-512-4408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OE1979
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License Number State | FL
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