Provider Demographics
NPI:1497825731
Name:SUN OPTIMUM SUPPLIES
Entity Type:Organization
Organization Name:SUN OPTIMUM SUPPLIES
Other - Org Name:SOS MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-957-4848
Mailing Address - Street 1:12834 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3902
Mailing Address - Country:US
Mailing Address - Phone:713-957-4848
Mailing Address - Fax:713-957-1011
Practice Address - Street 1:12834 MURPHY RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3902
Practice Address - Country:US
Practice Address - Phone:713-957-4848
Practice Address - Fax:713-957-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010910001Medicaid
TX010910001Medicaid