Provider Demographics
NPI:1386843795
Name:SUAL OPTICAL CORPORATION
Entity Type:Organization
Organization Name:SUAL OPTICAL CORPORATION
Other - Org Name:INTERNATIONAL OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LINO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-551-1245
Mailing Address - Street 1:10720 W FLAGLER ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4406
Mailing Address - Country:US
Mailing Address - Phone:305-551-1245
Mailing Address - Fax:
Practice Address - Street 1:10720 W FLAGLER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4406
Practice Address - Country:US
Practice Address - Phone:305-551-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========MedicaidOPTICAL