Provider Demographics
NPI:1699960849
Name:FRANK A. BROOME JR O.D.
Entity type:Organization
Organization Name:FRANK A. BROOME JR O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-253-5999
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32115-0351
Mailing Address - Country:US
Mailing Address - Phone:386-253-5999
Mailing Address - Fax:386-253-1193
Practice Address - Street 1:701 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5331
Practice Address - Country:US
Practice Address - Phone:386-253-5999
Practice Address - Fax:386-253-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3301152W00000X
FLOPC795152W00000X
FLOPC2982152W00000X
FLOPC3786152W00000X
FLOPC3283152W00000X
FLOPC876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0490600001Medicare NSC
FL99270CMedicare PIN
FL0490600002Medicare NSC
FL0490600003Medicare NSC
FL0490600004Medicare NSC
FL99270AMedicare PIN
FL99270BMedicare PIN
FL99270Medicare PIN