Provider Demographics
NPI:1649576059
Name:JOSEALIX DAVERMAN OD PA
Entity Type:Organization
Organization Name:JOSEALIX DAVERMAN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEALIX
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-249-7548
Mailing Address - Street 1:6841 MIRAMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6023
Mailing Address - Country:US
Mailing Address - Phone:954-967-9017
Mailing Address - Fax:
Practice Address - Street 1:5920 W SAMPLE RD # 105-7
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3251
Practice Address - Country:US
Practice Address - Phone:954-249-7548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OPC3885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9195136OtherAETNA
FL2775155OtherUNITED HEALTH CARE
36141OtherBLUECROSS BLUESHIELDS
FL3885OtherEYEMED
36141OtherBLUECROSS BLUESHIELDS
FL2775155OtherUNITED HEALTH CARE