Provider Demographics
NPI:1992982821
Name:MAX OPTICS, INC.
Entity type:Organization
Organization Name:MAX OPTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:RECORD
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:727-861-3536
Mailing Address - Street 1:PO BOX 5445
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-5445
Mailing Address - Country:US
Mailing Address - Phone:352-848-4222
Mailing Address - Fax:352-688-6994
Practice Address - Street 1:11721 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1051
Practice Address - Country:US
Practice Address - Phone:727-861-3536
Practice Address - Fax:727-861-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2261332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4133250001Medicare PIN