Provider Demographics
NPI:1568688133
Name:BREVARD EYE ASSOCIATES
Entity Type:Organization
Organization Name:BREVARD EYE ASSOCIATES
Other - Org Name:BREVARD EYE ASSOCIATES B. CARLTON LYNN, M.D., P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:321-636-2722
Mailing Address - Street 1:1264 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2746
Mailing Address - Country:US
Mailing Address - Phone:321-636-2722
Mailing Address - Fax:321-632-4109
Practice Address - Street 1:1264 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2746
Practice Address - Country:US
Practice Address - Phone:321-636-2722
Practice Address - Fax:321-632-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18207207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00412OtherBLUE CROSS BLUE SHIELD
10714580OtherCAQH
05294OtherBLUE CROSS BLUE SHIELD
1739227001OtherCIGNA
5013483OtherAETNA
AL5247348OtherDEA
AL5247348OtherDEA
05294OtherBLUE CROSS BLUE SHIELD