Provider Demographics
NPI:1164740114
Name:DRS. CUKIERMAN & GOMEZ, INC
Entity Type:Organization
Organization Name:DRS. CUKIERMAN & GOMEZ, INC
Other - Org Name:ADVANCED VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-471-6453
Mailing Address - Street 1:3682 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1148
Mailing Address - Country:US
Mailing Address - Phone:954-730-8087
Mailing Address - Fax:954-730-7201
Practice Address - Street 1:3682 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-1148
Practice Address - Country:US
Practice Address - Phone:954-730-8087
Practice Address - Fax:954-730-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103620900Medicaid
FL101685200Medicaid
FL000369300Medicaid