Provider Demographics
NPI:1881998862
Name:EAGLE EYES VISION CENTER LLC
Entity type:Organization
Organization Name:EAGLE EYES VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROBECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-399-0999
Mailing Address - Street 1:6 BLUEWATER POINT RD
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4503
Mailing Address - Country:US
Mailing Address - Phone:850-399-0999
Mailing Address - Fax:850-897-1288
Practice Address - Street 1:4526 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9755
Practice Address - Country:US
Practice Address - Phone:850-729-3937
Practice Address - Fax:850-678-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3676152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty