Provider Demographics
NPI:1902595259
Name:RAST, ANN ELIZABETH (LDO)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:ELIZABETH
Last Name:RAST
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:MRS
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:HAPPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDO
Mailing Address - Street 1:37421 ORANGE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-1822
Mailing Address - Country:US
Mailing Address - Phone:407-435-4292
Mailing Address - Fax:
Practice Address - Street 1:37421 ORANGE VALLEY LN
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-1822
Practice Address - Country:US
Practice Address - Phone:407-435-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6110156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician