Provider Demographics
NPI:1639676281
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:ALEXANDER
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-471-6453
Mailing Address - Street 1:246 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1721
Mailing Address - Country:US
Mailing Address - Phone:954-443-1230
Mailing Address - Fax:
Practice Address - Street 1:246 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1721
Practice Address - Country:US
Practice Address - Phone:954-443-1230
Practice Address - Fax:954-443-1234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS. CUKIERMAN & GOMEZ, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-10
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103620900Medicaid