MEDICARE: EYE ASSOCIATES OF MID FLORIDA, P.A.

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	OPC 4482	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902359003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE ASSOCIATES OF MID FLORIDA, P.A.

Provider Business Mailing Address
First Line	:	11794 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-4626
Country	:	US
Telephone Number	:	407-904-4431
Fax Number	:	407-904-4438

Provider Business Practice Location Address
First Line	:	11794 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-4626
Country	:	US
Telephone Number	:	407-904-4431
Fax Number	:	407-904-4438

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRANDON EB MONDESIR
Credential	:	O.D.
Telephone Number	:	407-904-4431

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	02/02/2024

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