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General NPI Number Information
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NPI Number | 1053685347
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Entity Type | Organization
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Legal Business Name | SUNRISE EYECARE
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Dates
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Enumeration Date | 03/04/2012
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Last Update Date | 03/04/2012
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Provider Practice Location Address
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Address Line | 1820 ALTACREST DR
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City | GRAPEVINE
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State | TX
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Zip | 76051-7326
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Country | US
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Telephone | 727-453-2260
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Fax | 817-416-8855
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Provider Business Mailing Address
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Address Line | 1820 ALTACREST DR
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City | GRAPEVINE
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State | TX
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Zip | 76051-7326
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Country | US
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Telephone | 727-453-2260
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Fax | 817-416-8855
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HUAN NGO V
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Credential | O.D
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Telephone | 727-453-2260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7137T
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License Number State | TX
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