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NPI Code Detail

MEDICARE: BERT MISNER OD & ASSOCIATES, INC

MEDICARE: BERT MISNER OD & ASSOCIATES, INC
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
1152W00000XOptometristOPC002199FL

General Provider Information

NPI Number : 1467753152
Entity Type Code : Organization
Provider Name (Legal Business Name) : BERT MISNER OD & ASSOCIATES, INC
Provider Business Mailing Address
First Line : 1040 MALABAR RD SE
Second Line :
City : PALM BAY
State : FL
Zip : 32907-3251
Country : US
Telephone Number : 321-984-3494
Fax Number : 321-723-2056
Provider Business Practice Location Address
First Line : 1040 MALABAR RD SE
Second Line :
City : PALM BAY
State : FL
Zip : 32907-3251
Country : US
Telephone Number : 321-984-3494
Fax Number : 321-723-2056
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIAM ALBERT MISNER
Credential : OD
Telephone Number : 321-984-3494
Provider Enumeration Date : 11/11/2010
Last Update Date : 11/11/2010

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