Provider Demographics
NPI:1437154283
Name:ARMITAGE, BRIAN S (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:ARMITAGE
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 1:8081 PHILIPS HWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7464
Mailing Address - Country:US
Mailing Address - Phone:904-739-2050
Mailing Address - Fax:904-733-3304
Practice Address - Street 1:8081 PHILIPS HWY
Practice Address - Street 2:SUITE 9
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7464
Practice Address - Country:US
Practice Address - Phone:904-739-2050
Practice Address - Fax:904-733-3304
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2648152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5724Medicare ID - Type Unspecified
FLU99831Medicare UPIN