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
Fax: (407) 903-1063
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255547295 NPPES
Arizona Other 1356 ARIZONA LICENSE
Arizona Other OPC2587 ARIZONA LICENSE
Arizona MEDICAID 078940200 ARIZONA LICENSE

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