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General NPI Number Information
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NPI Number | 1184849523
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Entity Type | Organization
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Legal Business Name | BREVARD EYE CENTER
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 1401 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-4295
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Country | US
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Telephone | 321-267-2980
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Fax | 321-267-2983
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Provider Business Mailing Address
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Address Line | 665 S APOLLO BLVD
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City | MELBOURNE
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State | FL
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Zip | 32901-1485
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Country | US
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Telephone | 321-984-2346
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Fax | 321-984-0032
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Authorized Official
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Title or Position | CEO
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Name | MR. GARY R HARDEY
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Credential |
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Telephone | 321-984-2346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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