Healthcare Provider Details

I. General information

NPI: 1093142986
Provider Name (Legal Business Name): BREVARD EYE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13848 NARCOOSSEE RD SUITE A104
ORLANDO FL
32832-6963
US

IV. Provider business mailing address

665 S APOLLO BLVD
MELBOURNE FL
32901-1485
US

V. Phone/Fax

Practice location:
  • Phone: 321-984-3200
  • Fax: 321-984-0032
Mailing address:
  • Phone: 321-984-3200
  • Fax: 321-984-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GARY R HARDEY
Title or Position: CEO
Credential: CEO
Phone: 321-984-3200