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General NPI Number Information
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NPI Number | 1063841633
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Entity Type | Organization
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Legal Business Name | BROOKS EYE CARE LLC
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 8890 SALROSE LN UNIT 203
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City | FORT MYERS
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State | FL
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Zip | 33912-2085
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Country | US
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Telephone | 239-789-7899
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Fax |
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Provider Business Mailing Address
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Address Line | 8034 SILVER BIRCH WAY
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-3769
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Country | US
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Telephone | 239-789-7899
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORDAN TROTTER BROOKS
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Credential | O.D.
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Telephone | 239-789-7899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 4115
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License Number State | FL
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