Provider Demographics
NPI:1013245331
Name:JAIME A. BALAGUER, JR., O.D., PA
Entity Type:Organization
Organization Name:JAIME A. BALAGUER, JR., O.D., PA
Other - Org Name:FLAMINGO FALLS EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALAGUER
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:954-433-1490
Mailing Address - Street 1:1770 NW 122ND TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1967
Mailing Address - Country:US
Mailing Address - Phone:954-433-1490
Mailing Address - Fax:954-433-0994
Practice Address - Street 1:1770 NW 122ND TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-1967
Practice Address - Country:US
Practice Address - Phone:954-433-1490
Practice Address - Fax:954-433-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621290500Medicaid