MEDICARE: DR. JAIME A GROSSMAN OD

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	OPC3117	FL

General Provider Information

NPI Number	:	1891869053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIME A GROSSMAN OD

Provider Business Mailing Address
First Line	:	542 ARTHUR GODFREY RD
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3510
Country	:	US
Telephone Number	:	305-534-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	542 ARTHUR GODFREY RD
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3510
Country	:	US
Telephone Number	:	305-534-3937
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	10/28/2019

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