Provider Demographics
NPI:1861668964
Name:FLEMING ISLAND VISION CENTER
Entity Type:Organization
Organization Name:FLEMING ISLAND VISION CENTER
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-260-3839
Mailing Address - Street 1:11406-1 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-260-3839
Mailing Address - Fax:
Practice Address - Street 1:1524 COUNTY ROAD 220 STE 5
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-4913
Practice Address - Country:US
Practice Address - Phone:904-637-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty