Provider Demographics
NPI:1215969357
Name:BRANDON EYE ASSOCIATES PA
Entity type:Organization
Organization Name:BRANDON EYE ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
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
Mailing Address - Street 2:SUITE 103
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 1:540 MEDICAL OAKS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5995
Practice Address - Country:US
Practice Address - Phone:813-684-2211
Practice Address - Fax:813-655-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2019-04-25
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
FL256356800Medicaid
FL4411430001Medicare NSC
FL21892Medicare PIN