Provider Demographics
NPI:1306041447
Name:SUNRISE VISION CARE, P.C.
Entity Type:Organization
Organization Name:SUNRISE VISION CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-449-0857
Mailing Address - Street 1:1692 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1034
Mailing Address - Country:US
Mailing Address - Phone:303-449-0857
Mailing Address - Fax:303-444-6560
Practice Address - Street 1:1692 30TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1034
Practice Address - Country:US
Practice Address - Phone:303-449-0857
Practice Address - Fax:303-444-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO387208Medicare PIN
CO4506580001Medicare NSC