=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184925596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNFOREST VISION CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2010
-----------------------------------------------------
Last Update Date | 11/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3915 SUNFOREST CT
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43623-4453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-475-9251
-----------------------------------------------------
Fax | 419-475-1407
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3915 SUNFOREST CT
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43623-4453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-475-9251
-----------------------------------------------------
Fax | 419-475-1407
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ABRAHAM YAP SIM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 419-475-9251
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number | 35-03-4485S
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------