Provider Demographics
NPI:1902359003
Name:EYE ASSOCIATES OF MID FLORIDA, P.A.
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF MID FLORIDA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:EB
Authorized Official - Last Name:MONDESIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-904-4431
Mailing Address - Street 1:11794 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4626
Mailing Address - Country:US
Mailing Address - Phone:407-904-4431
Mailing Address - Fax:407-904-4438
Practice Address - Street 1:11794 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4626
Practice Address - Country:US
Practice Address - Phone:407-904-4431
Practice Address - Fax:407-904-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016166600Medicaid
FL016166600Medicaid