Provider Demographics
NPI:1942380183
Name:MANDARIN VISION CENTER INC
Entity Type:Organization
Organization Name:MANDARIN VISION CENTER INC
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:904-446-7009
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:
Practice Address - Street 1:11407 SAN JOSE BLVD # 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7234
Practice Address - Country:US
Practice Address - Phone:904-260-3839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty