Provider Demographics
NPI:1497818561
Name:BOSHNICK, EDWARD LESLIE (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LESLIE
Last Name:BOSHNICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9960 SW 129 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176
Mailing Address - Country:US
Mailing Address - Phone:305-232-2093
Mailing Address - Fax:305-233-3145
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
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL909152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084349100Medicaid
FL3052644400OtherDR BOSHNICK VISION PLAN
T93814Medicare UPIN
FL084349100Medicaid