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General NPI Number Information
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NPI Number | 1528475506
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Entity Type | Organization
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Legal Business Name | BASCOM PALMER EYE INSTITUTE
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 900 NW 17TH ST
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City | MIAMI
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State | FL
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Zip | 33136-1119
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Country | US
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Telephone | 305-326-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 900 NW 17TH ST
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City | MIAMI
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State | FL
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Zip | 33136-1119
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Country | US
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Telephone | 305-326-6000
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SAVANNAH BRUNT
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Credential | O.D.
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Telephone | 304-859-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | OPC4969
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License Number State | FL
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