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General NPI Number Information
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NPI Number | 1376959916
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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 | 07/03/2014
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Last Update Date | 07/03/2014
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Provider Practice Location Address
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Address Line | 214 E MARKS ST
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City | ORLANDO
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State | FL
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Zip | 32803-3819
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Country | US
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Telephone | 407-841-6220
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Fax | 407-423-2285
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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 | 321-984-3200
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | ME98468
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License Number State | FL
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