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General NPI Number Information
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NPI Number | 1649576059
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Entity Type | Organization
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Legal Business Name | JOSEALIX DAVERMAN OD PA
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 5920 W SAMPLE RD # 105-7
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-3251
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Country | US
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Telephone | 954-249-7548
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Fax |
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Provider Business Mailing Address
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Address Line | 6841 MIRAMAR PKWY
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City | MIRAMAR
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State | FL
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Zip | 33023-6023
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Country | US
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Telephone | 954-967-9017
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEALIX DAVERMAN
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Credential | O.D.
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Telephone | 954-249-7548
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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 | OPC3885
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License Number State |
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