Provider Demographics
NPI:1568785426
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:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-260-3839
Mailing Address - Street 1:11406 SAN JOSE BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7963
Mailing Address - Country:US
Mailing Address - Phone:904-260-3839
Mailing Address - Fax:904-260-7879
Practice Address - Street 1:135 JENKINS ST
Practice Address - Street 2:STE104
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5175
Practice Address - Country:US
Practice Address - Phone:904-819-9251
Practice Address - Fax:904-819-9293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR TED BRINK &ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty