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General NPI Number Information
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NPI Number | 1861668964
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Entity Type | Organization
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Legal Business Name | FLEMING ISLAND VISION CENTER
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 1524 COUNTY ROAD 220 STE 5
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City | ORANGE PARK
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State | FL
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Zip | 32003-4913
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Country | US
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Telephone | 904-637-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 11406-1 SAN JOSE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32223
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Country | US
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Telephone | 904-260-3839
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THEODORE MELVIN BRINK
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Credential | OD
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Telephone | 904-260-3839
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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 | OPC3085
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License Number State | FL
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