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Organization
PEMBROKE LAKES OPTICAL INC
Active
Organization
PEMBROKE LAKES OPTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER L GOMEZ O.D. (PRESIDENT)
(954) 442-6703
Entity
Organization
Contact information
Practice address
1673 N HIATUS RD, PEMBROKE PINES, FL 33026-2129
(954) 442-6703
(954) 442-6769
Mailing address
1673 N HIATUS RD, PEMBROKE PINES, FL 33026-2129
(954) 442-6703
(954) 442-6769
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC3345
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620641701
—
FL
Enumeration date
06/18/2008
Last updated
06/18/2008
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