Provider Demographics
NPI:1215683206
Name:BRANDON EYE ASSOCIATES PA
Entity type:Organization
Organization Name:BRANDON EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLESHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-684-2211
Mailing Address - Street 1:540 MEDICAL OAKS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5995
Mailing Address - Country:US
Mailing Address - Phone:813-684-2211
Mailing Address - Fax:813-655-7669
Practice Address - Street 1:779 CORTARO DR
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6812
Practice Address - Country:US
Practice Address - Phone:813-213-0020
Practice Address - Fax:813-642-7357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANDON EYE ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256356803Medicaid