Provider Demographics
NPI:1730638313
Name:JAIME GOSSAN OD, PA
Entity Type:Organization
Organization Name:JAIME GOSSAN OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:SHOUSE
Authorized Official - Last Name:GOSSAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-357-0824
Mailing Address - Street 1:260 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4130
Mailing Address - Country:US
Mailing Address - Phone:954-725-0017
Mailing Address - Fax:954-725-0018
Practice Address - Street 1:260 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4130
Practice Address - Country:US
Practice Address - Phone:954-725-0017
Practice Address - Fax:954-725-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty