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General NPI Number Information
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NPI Number | 1982817631
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Entity Type | Individual
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Provider Name | FRANKLIN JAY RIVENSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 5571 W HILLSBORO BLVD
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4376
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Country | US
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Telephone | 561-574-6735
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Fax |
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Provider Business Mailing Address
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Address Line | 8022 TANGELO DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33436
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Country | US
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Telephone | 561-758-1254
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC 3762
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License Number State | FL
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