Provider Demographics
NPI:1003139957
Name:DR.TED BRINK & ASSOCIATES
Entity Type:Organization
Organization Name:DR.TED BRINK & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-331-6373
Mailing Address - Street 1:11406 SAN JOSE BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7963
Mailing Address - Country:US
Mailing Address - Phone:904-260-3839
Mailing Address - Fax:904-260-7879
Practice Address - Street 1:6405 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4338
Practice Address - Country:US
Practice Address - Phone:352-331-6373
Practice Address - Fax:352-331-6375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. TED BRINK & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty