Provider Demographics
NPI:1851825830
Name:SUNRISE VISTA LLC
Entity Type:Organization
Organization Name:SUNRISE VISTA LLC
Other - Org Name:MANN EYE 2 OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-446-7900
Mailing Address - Street 1:PO BOX 4615
Mailing Address - Street 2:MSC 275
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4615
Mailing Address - Country:US
Mailing Address - Phone:713-275-2457
Mailing Address - Fax:713-275-2496
Practice Address - Street 1:3612 AVENUE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-7604
Practice Address - Country:US
Practice Address - Phone:979-244-1440
Practice Address - Fax:979-244-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7443156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID - LOCATION DOES NOT ACCEPT MEDICARE/MEDICAID FOR OPTICAL