Forrest, Brett Wayne
Forrest, Brett Wayne is an sole proprietor health care provider with primary practice located at 4200 Conroy Rd Space L-201, Orlando FL 32839-2400. He recently has 3 registered licenses in different health care specialties including Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Occupational Vision, Eye and Vision Services Providers / Optometrist. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Forrest, Brett Wayne can be contacted via phone (407) 903-1018.Contact Information
Primary practice address
4200 Conroy Rd Space L-201
Orlando FL 32839-2400
Phone: (407) 903-1018
Fax: (407) 903-1063
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | OPC2587 | Florida |
Eye and Vision Services Providers / Occupational Vision | 152WX0102X | OPC2587 | Florida |
Eye and Vision Services Providers / Optometrist | 152W00000X | OPC2587 | Florida |
Profile Details
NPI number | 1255547295 |
---|---|
LBN Legal business name | Forrest, Brett Wayne |
Credentials | Doctor of Optometry (OD) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | May 15th, 2007 |
Last updated | May 3rd, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1255547295 | NPPES |
Arizona | Other | 1356 | ARIZONA LICENSE |
Arizona | Other | OPC2587 | ARIZONA LICENSE |
Arizona | MEDICAID | 078940200 | ARIZONA LICENSE |
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