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General NPI Number Information
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NPI Number | 1689838393
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Entity Type | Organization
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Legal Business Name | BROOME VISION INC
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 1474 W GRANADA BLVD SUITE 470
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City | ORMOND BEACH
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State | FL
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Zip | 32174-9187
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Country | US
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Telephone | 386-673-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 1474 W GRANADA BLVD STE 470
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City | ORMOND BEACH
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State | FL
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Zip | 32174-9187
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Country | US
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Telephone | 386-673-3011
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | KEVIN ANDREW BROOME
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Credential | O.D.
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Telephone | 386-253-5999
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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 | OPC3301
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License Number State | FL
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