Individual
DR. KEVIN ANDREW BROOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
701 S RIDGEWOOD AVE, DAYTONA BEACH, FL 32114-5331
(386) 253-5999
(386) 253-1193
Mailing address
701 S RIDGEWOOD AVE, DAYTONA BEACH, FL 32114-5331
(386) 253-5999
(386) 253-1193
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC3301
FL
152WC0802X
Corneal and Contact Management Optometrist
OPC3301
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620421000
—
FL
Enumeration date
06/23/2006
Last updated
04/12/2018
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