Provider Demographics
NPI:1275827297
Name:GOSSAN, JAIME SHOUSE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:SHOUSE
Last Name:GOSSAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 W PALMETTO PARK RD STE 25
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3462
Mailing Address - Country:US
Mailing Address - Phone:561-837-2228
Mailing Address - Fax:
Practice Address - Street 1:7050 W PALMETTO PARK RD STE 25
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3462
Practice Address - Country:US
Practice Address - Phone:561-837-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5011152W00000X
GAOPT002668152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty