Provider Demographics
NPI:1538246004
Name:BRIAN P DEN BESTE O D F A A O P A
Entity type:Organization
Organization Name:BRIAN P DEN BESTE O D F A A O P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOWNING
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-843-5665
Mailing Address - Street 1:120 EAST PAR STREET
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-843-5665
Mailing Address - Fax:407-872-7939
Practice Address - Street 1:120 EAST PAR STREET
Practice Address - Street 2:SUITE 2000
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-843-5665
Practice Address - Fax:407-872-7939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1632152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1449Medicare ID - Type Unspecified