MEDICARE: DR. JENNIFER BAUZA 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	OPC4423	FL

General Provider Information

NPI Number	:	1710211412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER BAUZA O.D.

Provider Business Mailing Address
First Line	:	5231 W 25TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-4072
Country	:	US
Telephone Number	:	786-333-3338
Fax Number	:

Provider Business Practice Location Address
First Line	:	12055 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-4112
Country	:	US
Telephone Number	:	754-400-2015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2009
Last Update Date	:	01/19/2012

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