Provider Demographics
NPI:1851706618
Name:SAB HOLDINGS LLC
Entity Type:Organization
Organization Name:SAB HOLDINGS LLC
Other - Org Name:TRU VISION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:URVASHI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-870-3212
Mailing Address - Street 1:400 N SECOND ST
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5227
Mailing Address - Country:US
Mailing Address - Phone:505-565-7754
Mailing Address - Fax:505-488-2687
Practice Address - Street 1:400 N SECOND ST
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5227
Practice Address - Country:US
Practice Address - Phone:505-565-7754
Practice Address - Fax:505-488-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-295268-006332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier