Provider Demographics
NPI:1497078380
Name:DR TED BRINK & ASSOCIATES
Entity Type:Organization
Organization Name:DR TED BRINK & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-260-3839
Mailing Address - Street 1:10300 SOUTHSIDE BLVD
Mailing Address - Street 2:238
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0770
Mailing Address - Country:US
Mailing Address - Phone:904-363-8282
Mailing Address - Fax:904-363-2263
Practice Address - Street 1:10300 SOUTHSIDE BLVD
Practice Address - Street 2:238
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0770
Practice Address - Country:US
Practice Address - Phone:904-363-8282
Practice Address - Fax:904-363-2263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. TED BRINK & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty