Active NPI
DRS. Cukierman & Gomez, Inc
- Optometrist
- Tamarac, FL
National Provider Identifier
1124455951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- DRS. CUKIERMAN & GOMEZ, INC
- Practice address
- 5865 N University Dr
Tamarac, FL 33321-4617 - Phone
- (954) 720-7201
- Fax
- (954) 726-6457
- NPI assigned
- Oct 13, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Michael A Gomez, O.D.
- Title
- Vice President
- Phone
- (954) 471-6453
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | Primary |
Addresses
Primary practice location
5865 N University Dr
Tamarac, FL 33321-4617
Mailing address
5865 N University Dr
Tamarac, FL 33321-4617
Phone (954) 720-7201
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103620900 | Medicaid | FL |
Other names 1
- Advanced Vision
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190918002359 | FL | Part B Supplier - Clinic/Group Practice | 9436489416 |
Receives reassigned benefits from 12 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Boca Raton, FL; Miami Gardens, FL; Pembroke Pines, FL |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1381622400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1596758400000",
"number": "1124455951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5865 N UNIVERSITY DR",
"city": "TAMARAC",
"state": "FL",
"postal_code": "333214617",
"telephone_number": "954-720-7201",
"fax_number": "954-726-6457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5865 N UNIVERSITY DR",
"city": "TAMARAC",
"state": "FL",
"postal_code": "333214617",
"telephone_number": "954-720-7201",
"fax_number": "954-726-6457"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DRS. CUKIERMAN & GOMEZ, INC",
"organizational_subpart": "NO",
"enumeration_date": "2013-10-13",
"last_updated": "2020-08-07",
"certification_date": "2020-08-07",
"status": "A",
"authorized_official_last_name": "GOMEZ",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "954-471-6453",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103620900",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Advanced Vision",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Advanced Vision",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tamarac, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.