Provider Demographics
NPI:1467900837
Name:SUNRISE VISTA LLC
Entity Type:Organization
Organization Name:SUNRISE VISTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-275-2460
Mailing Address - Street 1:PO BOX 4615
Mailing Address - Street 2:MSC 275
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4615
Mailing Address - Country:US
Mailing Address - Phone:713-580-2500
Mailing Address - Fax:713-275-2466
Practice Address - Street 1:9745 FM 1960 BYPASS RD W
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4069
Practice Address - Country:US
Practice Address - Phone:713-580-2500
Practice Address - Fax:713-275-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty