Provider Demographics
NPI:1528210481
Name:EYE CARE ASSOCIATES OF BREVARD P A
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF BREVARD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
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:SUITE #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:SUITE #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:2008-10-22
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2792152W00000X
FLOP2715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620058300Medicaid
FLCC4337Medicare PIN
FL620058300Medicaid
FL1162700001Medicare NSC