Healthcare Provider Details

I. General information

NPI: 1255702841
Provider Name (Legal Business Name): BREVARD EYE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 S APOLLO BLVD
MELBOURNE FL
32901-1485
US

IV. Provider business mailing address

1851 KNOX MCRAE DR
TITUSVILLE FL
32780-5492
US

V. Phone/Fax

Practice location:
  • Phone: 321-726-5984
  • Fax: 321-984-2620
Mailing address:
  • Phone: 321-269-3056
  • Fax: 321-984-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RAFAEL TRESPALACIOS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 321-726-5984