Basic Information
| Provider Information | |||||||||
| NPI: | 1801159801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14405 W COLFAX AVE | ||||||||
| Address2: | #310 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804013247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032150376 | ||||||||
| FaxNumber: | 3033026906 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 W ARROWHEAD TOWNE CTR | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853088616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234862121 | ||||||||
| FaxNumber: | 6234861145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2012 | ||||||||
| LastUpdateDate: | 06/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1858 | AZ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.