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General NPI Number Information
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NPI Number | 1992982821
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Entity Type | Organization
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Legal Business Name | MAX OPTICS, INC.
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 11721 US HIGHWAY 19
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City | PORT RICHEY
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State | FL
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Zip | 34668-1051
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Country | US
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Telephone | 727-861-3536
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Fax | 727-861-3536
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Provider Business Mailing Address
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Address Line | PO BOX 5445
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City | SPRING HILL
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State | FL
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Zip | 34611-5445
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Country | US
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Telephone | 352-848-4222
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Fax | 352-688-6994
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTHONY RECORD
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Credential | LDO
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Telephone | 727-861-3536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2261
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License Number State | FL
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