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General NPI Number Information
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NPI Number | 1962790972
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Entity Type | Organization
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Legal Business Name | BOCA FAMILY EYE CARE, LLC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 9858 CLINT MOORE RD
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 561-479-0521
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Fax | 561-479-0522
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Provider Business Mailing Address
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Address Line | 9858 CLINT MOORE RD
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 561-479-0521
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Fax | 561-479-0522
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. JONATHAN T NEBB
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Credential | OD
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Telephone | 703-447-1644
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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 |
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License Number State | FL
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