MEDICARE: DR. TED BRINKS & ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1376866228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. TED BRINKS & ASSOCIATES

Provider Business Mailing Address
First Line	:	11406 SAN JOSE BLVD
Second Line	:	STE 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-7963
Country	:	US
Telephone Number	:	904-260-3839
Fax Number	:

Provider Business Practice Location Address
First Line	:	4495 ROOSEVELT BLVD
Second Line	:	101
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3375
Country	:	US
Telephone Number	:	904-384-3707
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TED BRINK
Credential	:	MD
Telephone Number	:	904-260-3839

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	03/08/2010

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