Provider Demographics
NPI:1144209172
Name:SUNLAND OPTICAL CO., INC.
Entity type:Organization
Organization Name:SUNLAND OPTICAL CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-591-9483
Mailing Address - Street 1:1156 BARRANCA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-5095
Mailing Address - Country:US
Mailing Address - Phone:915-591-9483
Mailing Address - Fax:
Practice Address - Street 1:143 REPLACEMENT AVE
Practice Address - Street 2:BLD 487
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473
Practice Address - Country:US
Practice Address - Phone:573-329-4860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric AssistantGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty