Provider Demographics
NPI:1851376453
Name:ANHALT, ADAM A (OD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:A
Last Name:ANHALT
Suffix:
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 1:2521 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6630
Mailing Address - Country:US
Mailing Address - Phone:352-377-7733
Mailing Address - Fax:352-377-9577
Practice Address - Street 1:2521 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6630
Practice Address - Country:US
Practice Address - Phone:352-377-7733
Practice Address - Fax:352-377-9577
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2468152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU43779Medicare UPIN
FL20441ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #