Healthcare Provider Details

I. General information

NPI: 1215969357
Provider Name (Legal Business Name): BRANDON EYE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MEDICAL OAKS AVE SUITE 103
BRANDON FL
33511-5995
US

IV. Provider business mailing address

540 MEDICAL OAKS AVE SUITE 103
BRANDON FL
33511-5995
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-2211
  • Fax: 813-655-7669
Mailing address:
  • Phone: 813-684-2211
  • Fax: 813-655-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE FLESHNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-684-2211