Provider Demographics
NPI:1063841633
Name:BROOKS EYE CARE LLC
Entity Type:Organization
Organization Name:BROOKS EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:TROTTER
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-789-7899
Mailing Address - Street 1:8034 SILVER BIRCH WAY
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-3769
Mailing Address - Country:US
Mailing Address - Phone:239-789-7899
Mailing Address - Fax:
Practice Address - Street 1:8890 SALROSE LN
Practice Address - Street 2:UNIT 203
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-2085
Practice Address - Country:US
Practice Address - Phone:239-789-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9213090OtherCIGNA
FL621160700Medicaid
FL36003OtherBLUECROSS BLUESHIELD
FL9213090OtherCIGNA
FLV11560Medicare UPIN