Provider Demographics
NPI:1699032771
Name:SUNLAND OPTICAL CO., INC.
Entity Type:Organization
Organization Name:SUNLAND OPTICAL CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-591-9483
Mailing Address - Street 1:1156 BARRANCA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-5002
Mailing Address - Country:US
Mailing Address - Phone:915-591-9483
Mailing Address - Fax:915-225-0698
Practice Address - Street 1:5405 E GRANITE ST
Practice Address - Street 2:BLDG. 2527
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707-3004
Practice Address - Country:US
Practice Address - Phone:520-745-5669
Practice Address - Fax:520-514-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07371370332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier