NPIMap

Organization Active NPI

Brandon Eye Associates PA

Doing business as Brandon Eye Associates

  • Ophthalmology Physician
  • Brandon, FL
National Provider Identifier
1215969357
Registry record updated Apr 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
BRANDON EYE ASSOCIATES PA
Doing business as
Brandon Eye Associates
Practice address
540 Medical Oaks Ave
Suite 103
Brandon, FL 33511-5995
Phone
(813) 684-2211
Fax
(813) 655-7669
NPI assigned
Jul 7, 2006
Last updated
Apr 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Michelle Fleshner
Title
Administrator
Phone
(813) 684-2211

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

540 Medical Oaks Ave
Suite 103
Brandon, FL 33511-5995

Mailing address

540 Medical Oaks Ave
Suite 103
Brandon, FL 33511-5995
Phone (813) 684-2211

Other practice location 1

105 Southern Oaks Dr
Plant City, FL 33563-1451
Phone (813) 754-1869

Other practice location 2

779 Cortaro Dr
Sun City Center, FL 33573-6812
Phone (813) 213-0020

Other identifiers 1

IdentifierTypeStateIssuer
256356800MedicaidFL

Other names 1

  • BRANDON EYE ASSOCIATES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050120000740 FL Part B Supplier - Clinic/Group Practice 8022067677 Receives reassigned benefits from 10 practitioners
Practice locations: Plant City, FL; Brandon, FL
O20100930006826 FL DME Supplier - Physician - OptometristDME Supplier - Optician 8022067677 Practice locations: Brandon, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2070740Brandon Eye Associates540 Medical Oaks Ave Ste 103, Brandon, FL 33511Certificate of waiverDec 22, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Brandon Eye Associates540 Medical Oaks Ave, Brandon, FL 33511-5995(813) 684-2211 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Brandon Eye Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

540 Medical Oaks Ave
Ste 103
Brandon, FL 33511
Phone (813) 684-2211

Interoperability endpoints

  • Direct secure messaging: cbovee@brandoneyeassociates.intellechartdirect.net
  • Direct secure messaging: mhedayat@brandoneyeassociates.intellechartdirect.net
  • Direct secure messaging: tvanzandt@brandoneyeassociates.intellechartdirect.net

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556150400000",
    "number": "1215969357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 MEDICAL OAKS AVE",
            "address_2": "SUITE 103",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115995",
            "telephone_number": "813-684-2211",
            "fax_number": "813-655-7669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 MEDICAL OAKS AVE",
            "address_2": "SUITE 103",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115995",
            "telephone_number": "813-684-2211",
            "fax_number": "813-655-7669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 Southern Oaks Dr",
            "address_purpose": "LOCATION",
            "city": "Plant City",
            "state": "FL",
            "postal_code": "335631451",
            "country_code": "US",
            "telephone_number": "813-754-1869",
            "fax_number": "813-759-8570",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "779 Cortaro Dr",
            "address_purpose": "LOCATION",
            "city": "Sun City Center",
            "state": "FL",
            "postal_code": "335736812",
            "country_code": "US",
            "telephone_number": "813-213-0020",
            "fax_number": "813-642-7357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRANDON EYE ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2019-04-25",
        "status": "A",
        "authorized_official_last_name": "FLESHNER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "813-684-2211",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256356800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRANDON EYE ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BRANDON EYE ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.