Provider Demographics
NPI:1073728242
Name:BREVARD EYE CENTER
Entity Type:Organization
Organization Name:BREVARD EYE CENTER
Other - Org Name:PAUL J BEFANIS MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARDEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-984-3200
Mailing Address - Street 1:665 S APOLLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1485
Mailing Address - Country:US
Mailing Address - Phone:321-984-3200
Mailing Address - Fax:321-984-0032
Practice Address - Street 1:1221 S. PATRICK DRIVE
Practice Address - Street 2:#1364
Practice Address - City:PATRICK AIR FORCE BASE
Practice Address - State:FL
Practice Address - Zip Code:32925-3623
Practice Address - Country:US
Practice Address - Phone:321-783-8820
Practice Address - Fax:321-783-8962
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREVARD EYE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24403Medicare PIN