NPIMap

Organization Active NPI

Brevard Optometry Associates

Doing business as Brevard Vision Care

  • Optometrist
  • Melbourne, FL
National Provider Identifier
1710057054
Registry record updated Feb 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC1857 Issued in FL
Legal business name
BREVARD OPTOMETRY ASSOCIATES
Doing business as
Brevard Vision Care
Practice address
2420 S Babcock St
Melbourne, FL 32901-5356
Phone
(321) 725-4755
Fax
(321) 725-5088
NPI assigned
Nov 8, 2006
Last updated
Feb 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2008

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

Authorized official

Name
Ms. Rita E. Jimenez
Title
Practice Manager
Phone
(321) 725-4755

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OPC1857 FL Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OPC0891 FL
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OPC2189 FL
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OPC2747 FL
Corneal and Contact Management OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WC0802X OPC4006 FL

Addresses

Primary practice location

2420 S Babcock St
Melbourne, FL 32901-5356

Mailing address

2420 S Babcock St
Melbourne, FL 32901-5356
Phone (321) 725-4755

Other names 1

  • Brevard Vision Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070911000827 FL Part B Supplier - Clinic/Group Practice 1052417821 Receives reassigned benefits from 8 practitioners
Practice locations: Melbourne, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1710057054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2420 S BABCOCK ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015356",
            "telephone_number": "321-725-4755",
            "fax_number": "321-725-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 S BABCOCK ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015356",
            "telephone_number": "321-725-4755",
            "fax_number": "321-725-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD OPTOMETRY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "RITA",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "321-725-4755",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC1857",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC0891",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC2189",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC2747",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "FL",
            "license": "OPC4006",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brevard Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.