Provider Demographics
NPI:1598935363
Name:SPRING HILL OPTICAL
Entity Type:Organization
Organization Name:SPRING HILL OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LDO/ OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATI
Authorized Official - Middle Name:M
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LIC DISP OPTICIAN
Authorized Official - Phone:352-683-2020
Mailing Address - Street 1:1380 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4500
Mailing Address - Country:US
Mailing Address - Phone:352-683-2020
Mailing Address - Fax:
Practice Address - Street 1:1380 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4500
Practice Address - Country:US
Practice Address - Phone:352-683-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
5004050001Medicare NSC