Provider Demographics
NPI:1093954539
Name:SIERRA OPTICAL
Entity Type:Organization
Organization Name:SIERRA OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-593-6801
Mailing Address - Street 1:1200 GOLDEN KEY CIR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5820
Mailing Address - Country:US
Mailing Address - Phone:915-593-6801
Mailing Address - Fax:
Practice Address - Street 1:1200 GOLDEN KEY CIR
Practice Address - Street 2:SUITE 160
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5820
Practice Address - Country:US
Practice Address - Phone:915-593-6801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5314530001Medicare NSC