Provider Demographics
NPI:1689890386
Name:JASON B C BINNING O.D., P.A.
Entity Type:Organization
Organization Name:JASON B C BINNING O.D., P.A.
Other - Org Name:EYESITE OPTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BC
Authorized Official - Last Name:BINNING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-966-3808
Mailing Address - Street 1:6626 HYPOLUXO RD
Mailing Address - Street 2:SUITE A4
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7676
Mailing Address - Country:US
Mailing Address - Phone:561-966-3808
Mailing Address - Fax:561-966-3191
Practice Address - Street 1:6626 HYPOLUXO RD
Practice Address - Street 2:SUITE A4
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7676
Practice Address - Country:US
Practice Address - Phone:561-966-3808
Practice Address - Fax:561-966-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC043Medicare PIN