Healthcare Provider Details

I. General information

NPI: 1568785426
Provider Name (Legal Business Name): DR TED BRINK & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 JENKINS ST STE104
ST AUGUSTINE FL
32086-5175
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 904-819-9251
  • Fax: 904-819-9293
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: 904-260-3839