Provider Demographics
NPI:1679746515
Name:BRAVO EYE CARE CENTER INC
Entity type:Organization
Organization Name:BRAVO EYE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-553-2354
Mailing Address - Street 1:325 MARION OAKS CRSE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-2335
Mailing Address - Country:US
Mailing Address - Phone:352-553-2354
Mailing Address - Fax:352-291-0361
Practice Address - Street 1:325 MARION OAKS CRSE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-2335
Practice Address - Country:US
Practice Address - Phone:352-553-2354
Practice Address - Fax:352-291-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty