Provider Demographics
NPI:1093142986
Name:BREVARD EYE CENTER INC
Entity Type:Organization
Organization Name:BREVARD EYE CENTER INC
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:CEO
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 1:13848 NARCOOSSEE RD
Practice Address - Street 2:SUITE A104
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6963
Practice Address - Country:US
Practice Address - Phone:321-984-3200
Practice Address - Fax:321-984-0032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREVARD EYE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-09
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1558456681OtherGROUP NPI
FL=========OtherGROUP TAX ID