Provider Demographics
NPI:1538367768
Name:ALLIED EYECARE, LCC D/B/A ADVANTICA EYECARE
Entity type:Organization
Organization Name:ALLIED EYECARE, LCC D/B/A ADVANTICA EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, NETWORK MANAGEMENT & CONT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1866-425-2323
Mailing Address - Street 1:19321 US HIGHWAY 19 N # C
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-3169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19321 US HIGHWAY 19 N # C
Practice Address - Street 2:SUITE 320
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-3169
Practice Address - Country:US
Practice Address - Phone:866-425-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty