Provider Demographics
NPI:1467753152
Name:BERT MISNER OD & ASSOCIATES, INC
Entity Type:Organization
Organization Name:BERT MISNER OD & ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:MISNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-984-3494
Mailing Address - Street 1:1040 MALABAR RD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3251
Mailing Address - Country:US
Mailing Address - Phone:321-984-3494
Mailing Address - Fax:321-723-2056
Practice Address - Street 1:1040 MALABAR RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3251
Practice Address - Country:US
Practice Address - Phone:321-984-3494
Practice Address - Fax:321-723-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty