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NPI Code Detail

MEDICARE: DR. JOHN HARDY BASCOME V O.D.

MEDICARE: DR. JOHN HARDY BASCOME V O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist004568FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184927105
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN HARDY BASCOME V O.D.
Provider Business Mailing Address
First Line : 2502 E OAKLAND PARK BLVD
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33306-1601
Country : US
Telephone Number : 954-564-2020
Fax Number : 954-565-4671
Provider Business Practice Location Address
First Line : 2502 E OAKLAND PARK BLVD
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33306-1601
Country : US
Telephone Number : 954-564-2020
Fax Number : 954-565-4671
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2010
Last Update Date : 01/10/2014

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