| Brenda Deforrest Od Pa | |
|
4884 S Kirkman Rd Orlando FL 32811-3641 | |
| (407) 289-8819 | |
| Not Available |
| Full Name | Brenda Deforrest Od Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 4884 S Kirkman Rd, Orlando, Florida |
| Authorized Official Name and Position | Brenda Deforrest (PRESIDENT) |
| Authorized Official Contact | 4072988819 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brenda Deforrest Od Pa 4884 S Kirkman Rd Orlando FL 32811-3641 Ph: (407) 289-8819 | Brenda Deforrest Od Pa 4884 S Kirkman Rd Orlando FL 32811-3641 Ph: (407) 289-8819 |
| NPI Number | 1477733780 |
|---|---|
| Provider Enumeration Date | 11/05/2007 |
| Last Update Date | 06/02/2008 |
| Medicare PECOS PAC ID | 6901975515 |
|---|---|
| Medicare Enrollment ID | O20080522000497 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477733780 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | FL2617 (Florida) | Primary |
| Provider Name | Brenda L Deforrest |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1619029303 PECOS PAC ID: 4688763352 Enrollment ID: I20071203000566 |
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