Provider Demographics
NPI:1194203877
Name:SAMY OPTICAL LLC
Entity Type:Organization
Organization Name:SAMY OPTICAL LLC
Other - Org Name:SITE FOR SORE EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EFFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-421-2020
Mailing Address - Street 1:1350 TRAVIS BLVD UNIT 1507A
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 TRAVIS BLVD UNIT 1507A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3440
Practice Address - Country:US
Practice Address - Phone:707-421-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier