Provider Demographics
NPI:1124455951
Name:DRS. CUKIERMAN & GOMEZ, INC
Entity type:Organization
Organization Name:DRS. CUKIERMAN & GOMEZ, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-471-6453
Mailing Address - Street 1:5865 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4617
Mailing Address - Country:US
Mailing Address - Phone:954-720-7201
Mailing Address - Fax:954-726-6457
Practice Address - Street 1:5865 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4617
Practice Address - Country:US
Practice Address - Phone:954-720-7201
Practice Address - Fax:954-726-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-13
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103620900Medicaid
FL000369301Medicaid