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General NPI Number Information
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NPI Number | 1104244847
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Entity Type | Organization
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Legal Business Name | SUNRISE OPTICAL CORP
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 2210 SUNRISE MALL
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4348
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Country | US
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Telephone | 516-795-2112
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Fax | 516-795-2167
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Provider Business Mailing Address
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Address Line | 2210 SUNRISE MALL
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4348
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Country | US
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Telephone | 516-795-2112
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Fax | 516-795-2167
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LAURA VALENTIN
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Credential |
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Telephone | 212-792-8149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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