Provider Demographics
NPI:1790544922
Name:SUNRISE EYECARE SPECIALTY LENSES AND DRY EYE INSTITUTE
Entity Type:Organization
Organization Name:SUNRISE EYECARE SPECIALTY LENSES AND DRY EYE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURJOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-851-9949
Mailing Address - Street 1:12555 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-0900
Mailing Address - Country:US
Mailing Address - Phone:954-851-9949
Mailing Address - Fax:
Practice Address - Street 1:12555 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-0900
Practice Address - Country:US
Practice Address - Phone:954-851-9949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty