Provider Demographics
NPI:1740757871
Name:ANYTIME OPTICAL LLC
Entity Type:Organization
Organization Name:ANYTIME OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-886-2020
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33575-0585
Mailing Address - Country:US
Mailing Address - Phone:813-886-2020
Mailing Address - Fax:888-805-7385
Practice Address - Street 1:25 W COLLEGE AVE STE A
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4701
Practice Address - Country:US
Practice Address - Phone:813-886-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty