Healthcare Provider Details

I. General information

NPI: 1003139957
Provider Name (Legal Business Name): DR.TED BRINK & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2010
Last Update Date: 03/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 W NEWBERRY RD
GAINESVILLE FL
32605-4338
US

IV. Provider business mailing address

11406 SAN JOSE BLVD STE 1
JACKSONVILLE FL
32223-7963
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-6373
  • Fax: 352-331-6375
Mailing address:
  • Phone: 904-260-3839
  • Fax: 904-260-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. TED BRINK
Title or Position: PRESIDENT
Credential:
Phone: 352-331-6373