Provider Demographics
NPI:1578004354
Name:AMERICAN OPTOMETRIC CENTER CORP
Entity Type:Organization
Organization Name:AMERICAN OPTOMETRIC CENTER CORP
Other - Org Name:BROOKSVILLE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-796-0340
Mailing Address - Street 1:PO BOX 10257
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34603-0257
Mailing Address - Country:US
Mailing Address - Phone:352-796-0340
Mailing Address - Fax:352-777-4917
Practice Address - Street 1:7631 HORSE LAKE RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-9021
Practice Address - Country:US
Practice Address - Phone:352-796-0340
Practice Address - Fax:352-777-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630340400Medicaid
FL023749100Medicaid