MEDICARE: SUNLAND OPTICAL CO., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1639437791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNLAND OPTICAL CO., INC.

Provider Business Mailing Address
First Line	:	1156 BARRANCA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-5002
Country	:	US
Telephone Number	:	915-591-9483
Fax Number	:	915-225-0698

Provider Business Practice Location Address
First Line	:	330 KANSAS AVE BLDG 700
Second Line	:
City	:	FORT LEAVENWORTH
State	:	KS
Zip	:	66027-1139
Country	:	US
Telephone Number	:	913-651-3526
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. MARK WILLIAM MUSGRAVE
Credential	:
Telephone Number	:	915-591-9483

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	04/26/2012

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Directions to “SUNLAND OPTICAL CO., INC. ” Practice Location

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