Provider Demographics
NPI:1821354861
Name:SIGHT AND SUN EYEWORKS LLC
Entity Type:Organization
Organization Name:SIGHT AND SUN EYEWORKS LLC
Other - Org Name:CLARKSON EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:VIVIANA
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:AMA, CPO
Authorized Official - Phone:850-479-7379
Mailing Address - Street 1:15933 CLAYTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:850-479-7379
Mailing Address - Fax:850-497-6219
Practice Address - Street 1:6096 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-5062
Practice Address - Country:US
Practice Address - Phone:636-200-4393
Practice Address - Fax:850-623-4200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGHT AND SUN EYEWORKS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-04
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97937OtherFLORIDA BLUE
FL001650400Medicaid
FL97937OtherFLORIDA BLUE