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General NPI Number Information
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NPI Number | 1477733780
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Entity Type | Organization
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Legal Business Name | BRENDA DEFORREST OD PA
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 5006 DR PHILLIPS BLVD
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City | ORLANDO
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State | FL
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Zip | 32819-3310
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Country | US
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Telephone | 407-289-8819
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Fax | 407-296-7121
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Provider Business Mailing Address
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Address Line | 5006 DR PHILLIPS BLVD
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City | ORLANDO
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State | FL
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Zip | 32819-3310
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Country | US
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Telephone | 407-289-8819
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Fax | 407-296-7121
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRENDA DEFORREST
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Credential | OD
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Telephone | 407-298-8819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | FL2617
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License Number State | FL
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