Healthcare Provider Details

I. General information

NPI: 1750959896
Provider Name (Legal Business Name): SIGHT AND SUN EYEWORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 E IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34744-5401
US

IV. Provider business mailing address

PO BOX 207151
DALLAS TX
75320-7151
US

V. Phone/Fax

Practice location:
  • Phone: 407-847-0057
  • Fax: 407-518-0003
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JAMES WACHTER
Title or Position: CMO
Credential:
Phone: 636-200-4393