Provider Demographics
NPI:1942502091
Name:EDWARD L BOSHNICK OD PA
Entity Type:Organization
Organization Name:EDWARD L BOSHNICK OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOSHNICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-271-8206
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE B-270
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-271-8206
Mailing Address - Fax:305-271-8209
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:SUITE B-270
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-271-8206
Practice Address - Fax:305-271-8209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL909152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19524OtherMEDICARE PTAN
FL084349100Medicaid
FL084349100Medicaid