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General NPI Number Information
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NPI Number | 1710057054
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Entity Type | Organization
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Legal Business Name | BREVARD OPTOMETRY ASSOCIATES
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 2420 S BABCOCK ST
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City | MELBOURNE
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State | FL
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Zip | 32901-5356
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Country | US
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Telephone | 321-725-4755
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Fax | 321-725-5088
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Provider Business Mailing Address
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Address Line | 2420 S BABCOCK ST
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City | MELBOURNE
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State | FL
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Zip | 32901-5356
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Country | US
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Telephone | 321-725-4755
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Fax | 321-725-5088
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. RITA E. JIMENEZ
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Credential |
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Telephone | 321-725-4755
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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 | OPC0891
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC2189
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC2747
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPC4006
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC1857
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License Number State | FL
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