Provider Demographics
NPI:1477954352
Name:BRANDON PROFESSIONAL EYECARE ASSOCIATES, INC.
Entity type:Organization
Organization Name:BRANDON PROFESSIONAL EYECARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:601-859-3464
Mailing Address - Street 1:1185 HART ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4805
Mailing Address - Country:US
Mailing Address - Phone:601-859-3464
Mailing Address - Fax:601-859-9003
Practice Address - Street 1:1390 W GOVERNMENT ST STE C
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3273
Practice Address - Country:US
Practice Address - Phone:601-825-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty