Provider Demographics
NPI:1689283160
Name:BIEN AIME, MAGNUM (LDO)
Entity Type:Individual
Prefix:
First Name:MAGNUM
Middle Name:
Last Name:BIEN AIME
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W PALMETTO PARK RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3828
Mailing Address - Country:US
Mailing Address - Phone:561-368-5844
Mailing Address - Fax:561-368-6681
Practice Address - Street 1:122 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3828
Practice Address - Country:US
Practice Address - Phone:561-368-5844
Practice Address - Fax:561-368-5844
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6822156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician