MEDICARE: FRANK A. BROOME JR 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
1	152W00000X	Optometrist	OPC3301	FL
2	152W00000X	Optometrist	OPC2982	FL
3	152W00000X	Optometrist	OPC3786	FL
4	152W00000X	Optometrist	OPC3283	FL
5	152W00000X	Optometrist	OPC876	FL
6	152W00000X	Optometrist	OPC795	FL

General Provider Information

NPI Number	:	1659541068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANK A. BROOME JR O.D.

Provider Business Mailing Address
First Line	:	701 S RIDGEWOOD AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5331
Country	:	US
Telephone Number	:	386-253-5999
Fax Number	:	386-258-3973

Provider Business Practice Location Address
First Line	:	3781 S NOVA RD STE O
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4285
Country	:	US
Telephone Number	:	386-253-5999
Fax Number	:	386-258-3973

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL.OPTOMETRIST
Name	:	DR. KEVIN A BROOME
Credential	:	O.D.
Telephone Number	:	386-253-5999

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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