Basic Information
| Provider Information | |||||||||
| NPI: | 1427513167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAVO-BEAUMONT | ||||||||
| FirstName: | JASMINE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 BOSTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077757654 | ||||||||
| FaxNumber: | 4078346082 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 WESTMINSTER LN | ||||||||
| Address2: | |||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194605742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138929346 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2019 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC005736 | FL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OEG003503 | PA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.