NPIMap

Organization Active NPI

Pembroke Lakes Optical Inc

  • Optometrist
  • Pembroke Pines, FL
National Provider Identifier
1780845222
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC3345 Issued in FL
Legal business name
PEMBROKE LAKES OPTICAL INC
Practice address
1673 N Hiatus Rd
Pembroke Pines, FL 33026-2129
Phone
(954) 442-6703
Fax
(954) 442-6769
NPI assigned
Jun 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Peter L Gomez, O.D.
Title
President
Phone
(954) 442-6703

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPC3345 FL Primary

Addresses

Primary practice location

1673 N Hiatus Rd
Pembroke Pines, FL 33026-2129

Mailing address

1673 N Hiatus Rd
Pembroke Pines, FL 33026-2129
Phone (954) 442-6703

Other identifiers 1

IdentifierTypeStateIssuer
620641701MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1780845222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1673 N HIATUS RD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330262129",
            "telephone_number": "954-442-6703",
            "fax_number": "954-442-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1673 N HIATUS RD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330262129",
            "telephone_number": "954-442-6703",
            "fax_number": "954-442-6769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMBROKE LAKES OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-18",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-442-6703",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620641701",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.