Basic Information
| Provider Information | |||||||||
| NPI: | 1639437791 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNLAND OPTICAL CO., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1156 BARRANCA DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799355002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155919483 | ||||||||
| FaxNumber: | 9152250698 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 KANSAS AVE BLDG 700 | ||||||||
| Address2: | |||||||||
| City: | FORT LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660271139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136513526 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2012 | ||||||||
| LastUpdateDate: | 04/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | MUSGRAVE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9155919483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.