Provider Demographics
NPI:1275501199
Name:PARSONS, BRENT EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:EDWARD
Last Name:PARSONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12964 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2806
Mailing Address - Country:US
Mailing Address - Phone:813-960-8896
Mailing Address - Fax:813-960-3248
Practice Address - Street 1:18510 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-7900
Practice Address - Country:US
Practice Address - Phone:813-960-8896
Practice Address - Fax:813-960-3248
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL#OPC3305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620412100Medicaid
FLU74618Medicare UPIN
FLE2342CMedicare ID - Type Unspecified