Provider Demographics
NPI:1932386620
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 1:876 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4723
Practice Address - Country:US
Practice Address - Phone:636-200-4393
Practice Address - Fax:850-934-1179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGHT AND SUN EYEWORKS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-25
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97937OtherFLORIDA BLUE
FL001650400Medicaid
FLBW904GMedicare PIN
FL6159070001Medicare NSC
FL6159070001Medicare NSC
FL621158500Medicaid
FL003KYOtherBCBS OF FL