Provider Demographics
NPI:1255702841
Name:BREVARD EYE CENTER INC
Entity type:Organization
Organization Name:BREVARD EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRESPALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-726-5984
Mailing Address - Street 1:1851 KNOX MCRAE DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5492
Mailing Address - Country:US
Mailing Address - Phone:321-269-3056
Mailing Address - Fax:321-984-2620
Practice Address - Street 1:665 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1485
Practice Address - Country:US
Practice Address - Phone:321-726-5984
Practice Address - Fax:321-984-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty