Provider Demographics
NPI:1447580071
Name:SURE VISION EYE CARE LLC
Entity Type:Organization
Organization Name:SURE VISION EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BRENCI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-678-8876
Mailing Address - Street 1:1187 JOHN SIMS PKWY E
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2752
Mailing Address - Country:US
Mailing Address - Phone:850-678-8876
Mailing Address - Fax:850-729-8787
Practice Address - Street 1:1187 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2752
Practice Address - Country:US
Practice Address - Phone:850-678-8876
Practice Address - Fax:850-729-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCQ292AMedicare UPIN