Provider Demographics
NPI:1891820684
Name:DEMPSEY, BRENT J (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:J
Last Name:DEMPSEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1546
Mailing Address - Country:US
Mailing Address - Phone:727-824-0721
Mailing Address - Fax:727-824-0721
Practice Address - Street 1:5530 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-2252
Practice Address - Country:US
Practice Address - Phone:727-526-8828
Practice Address - Fax:727-522-2032
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT93957Medicare UPIN
FL19150Medicare ID - Type Unspecified