Provider Demographics
NPI:1174308670
Name:RECORD, ANTHONY DAVID (LDO)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DAVID
Last Name:RECORD
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:13300 CORTEZ BOULEVARD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-597-1577
Practice Address - Fax:352-596-2668
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO2281156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician