Provider Demographics
NPI:1376085308
Name:EYECARE IN BREVARD INC
Entity Type:Organization
Organization Name:EYECARE IN BREVARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREGAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-253-3550
Mailing Address - Street 1:3200 N WICKHAM RD
Mailing Address - Street 2:STE 1
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2321
Mailing Address - Country:US
Mailing Address - Phone:321-253-3550
Mailing Address - Fax:321-253-3591
Practice Address - Street 1:3200 N WICKHAM RD
Practice Address - Street 2:STE 1
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2321
Practice Address - Country:US
Practice Address - Phone:321-253-3550
Practice Address - Fax:321-253-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty