Provider Demographics
NPI:1942572565
Name:SIGHT AND SUN EYEWORKS TALLAHASSEE INC
Entity Type:Organization
Organization Name:SIGHT AND SUN EYEWORKS TALLAHASSEE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-224-1184
Mailing Address - Street 1:5113 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2035
Mailing Address - Country:US
Mailing Address - Phone:850-479-7379
Mailing Address - Fax:850-497-6219
Practice Address - Street 1:547 N MONROE ST
Practice Address - Street 2:SUITE A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-0619
Practice Address - Country:US
Practice Address - Phone:850-224-1184
Practice Address - Fax:850-224-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004715100Medicaid
FLGB679AMedicare PIN
FL6685430002Medicare NSC