Individual
DR. JERRY BEAUCHAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1625 NW 107TH AVE, DORAL, FL 33172-2707
(305) 470-7866
Mailing address
12925 SW 74TH CT, MIAMI, FL 33156-5356
(305) 251-6555
(305) 254-6336
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC1715
FL
Other
Enumeration date
02/16/2007
Last updated
07/08/2007
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