Provider Demographics
NPI:1366555021
Name:BRENNAN, JOHN PATRICK SR (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:BRENNAN
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S PARROTT AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-5138
Mailing Address - Country:US
Mailing Address - Phone:863-467-0595
Mailing Address - Fax:863-467-1686
Practice Address - Street 1:710 S PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-5138
Practice Address - Country:US
Practice Address - Phone:863-467-0595
Practice Address - Fax:863-467-1686
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLOPC 000971152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19044OtherBLUE CROSS BLUE SHIELD
FL084047500Medicaid
FLAK139Medicare PIN
FL0536130001Medicare NSC