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General NPI Number Information
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NPI Number | 1427138650
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Entity Type | Organization
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Legal Business Name | DR. TED BRINK AND ASSOCIATES PA
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 11406 SAN JOSE BLVD STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32223-7953
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Country | US
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Telephone | 904-260-3839
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Fax |
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Provider Business Mailing Address
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Address Line | 12276 SAN JOSE BLVD STE 305
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8632
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Country | US
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Telephone | 904-503-3565
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Fax | 904-647-9620
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Authorized Official
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Title or Position | DIRECTOR OF INSURANCE AND TRAINING
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Name | MELISSA JACOBSON
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Credential |
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Telephone | 904-446-7009
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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 |
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License Number State |
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