Provider Demographics
NPI:1073907176
Name:SUNRISE EYEWEAR AND OPTOMETRY, INC.
Entity Type:Organization
Organization Name:SUNRISE EYEWEAR AND OPTOMETRY, INC.
Other - Org Name:SUNRISE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-274-0998
Mailing Address - Street 1:1818 TULLY RD
Mailing Address - Street 2:158B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1883
Mailing Address - Country:US
Mailing Address - Phone:408-274-0998
Mailing Address - Fax:408-274-2060
Practice Address - Street 1:1818 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1883
Practice Address - Country:US
Practice Address - Phone:408-274-0998
Practice Address - Fax:408-274-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11933305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAUO8598Medicare UPIN
CASD0119330Medicare PIN