Individual
DR. JOHN HARDY BASCOME V
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2502 E OAKLAND PARK BLVD, FT LAUDERDALE, FL 33306-1601
(954) 564-2020
(954) 565-4671
Mailing address
2502 E OAKLAND PARK BLVD, FORT LAUDERDALE, FL 33306-1601
(954) 564-2020
(954) 565-4671
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
004568
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008988600
MEDICAID GROUP
FL
05
—
008992900
—
FL
Enumeration date
12/14/2010
Last updated
01/10/2014
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