Basic Information
| Provider Information | |||||||||
| NPI: | 1144209172 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNLAND OPTICAL CO., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1156 BARRANCA DR | ||||||||
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| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799355095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155919483 | ||||||||
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| Practice Location | |||||||||
| Address1: | 143 REPLACEMENT AVE | ||||||||
| Address2: | BLD 487 | ||||||||
| City: | FORT LEONARD WOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733294860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | BERNAL | ||||||||
| AuthorizedOfficialFirstName: | YVONNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 9155919483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1201X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optometric Assistant | 156FX1800X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician | 152W00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.