Provider Demographics
NPI:1841245248
Name:SUNSET OPTOMETRIC CENTER A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SUNSET OPTOMETRIC CENTER A PROFESSIONAL CORPORATION
Other - Org Name:DR. ROMEO J. GARZA - OPTOMETRIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-668-2702
Mailing Address - Street 1:4445 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6017
Mailing Address - Country:US
Mailing Address - Phone:323-668-2702
Mailing Address - Fax:323-668-1210
Practice Address - Street 1:4445 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6017
Practice Address - Country:US
Practice Address - Phone:323-668-2702
Practice Address - Fax:323-668-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP6225T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0062250Medicaid
CASD0062250Medicaid
CAWY155Medicare PIN