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General NPI Number Information
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NPI Number | 1558737163
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Entity Type | Organization
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Legal Business Name | SUN GALLERY ENTERPRISES
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 463867 SR 200 SUITE 4
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City | YULEE
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State | FL
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Zip | 32097
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Country | US
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Telephone | 904-277-2779
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Fax |
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Provider Business Mailing Address
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Address Line | 463867 SR 200 SUITE 4
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City | YULEE
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State | FL
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Zip | 32097
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Country | US
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Telephone | 904-277-2779
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MICHAEL F SHARPE
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Credential | OWNER
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Telephone | 904-277-2779
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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 | OE 2033
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License Number State | FL
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