Provider Demographics
NPI:1427513167
Name:BRAVO-BEAUMONT, JASMINE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:MARIE
Last Name:BRAVO-BEAUMONT
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4798
Mailing Address - Country:US
Mailing Address - Phone:407-775-7654
Mailing Address - Fax:407-834-6082
Practice Address - Street 1:40 WESTMINSTER LN
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-5742
Practice Address - Country:US
Practice Address - Phone:813-892-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003503152W00000X
FLOPC005736152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist