=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386918860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNNY M. FIELD, O.D., F.A.A.O., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2012
-----------------------------------------------------
Last Update Date | 03/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1225 STATE HIGHWAY 276
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-9376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-772-1613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 153 YORKSHIRE DR
-----------------------------------------------------
City | HEATH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-6648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/OWNER
-----------------------------------------------------
Name | DR. SUNNY FIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-592-3161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7304T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------