Provider Demographics
NPI:1902138407
Name:SANTALUZ LIMITED, LLC
Entity Type:Organization
Organization Name:SANTALUZ LIMITED, LLC
Other - Org Name:BREVIER OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:TRUCANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-401-1701
Mailing Address - Street 1:143 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3030
Mailing Address - Country:US
Mailing Address - Phone:952-401-1701
Mailing Address - Fax:952-401-7908
Practice Address - Street 1:143 OAK ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-3030
Practice Address - Country:US
Practice Address - Phone:952-401-1701
Practice Address - Fax:952-401-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty