Active NPI
Jerry Beauchamp, O.D.
- Optometrist
- Doral, FL
National Provider Identifier
1043354541
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC1715
- Practice address
- 1625 NW 107TH Ave
Doral, FL 33172-2707 - Phone
- (305) 470-7866
- NPI assigned
- Feb 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC1715 | FL | Primary |
Addresses
Primary practice location
1625 NW 107TH Ave
Doral, FL 33172-2707
Mailing address
12925 SW 74TH CT
Miami, FL 33156-5356
Phone (305) 251-6555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPC1715 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043354541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12925 SW 74TH CT",
"city": "MIAMI",
"state": "FL",
"postal_code": "331565356",
"telephone_number": "305-251-6555",
"fax_number": "305-254-6336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 NW 107TH AVE",
"city": "DORAL",
"state": "FL",
"postal_code": "331722707",
"telephone_number": "305-470-7866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAUCHAMP",
"first_name": "JERRY",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC1715",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Doral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.