Provider Demographics
NPI:1982375184
Name:SAPPAL OPTOMETRY SERVICES, INC.
Entity Type:Organization
Organization Name:SAPPAL OPTOMETRY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TOMIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-493-2632
Mailing Address - Street 1:1350 TRAVIS BLVD UNIT 1507A
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3440
Mailing Address - Country:US
Mailing Address - Phone:707-421-2020
Mailing Address - Fax:707-425-4266
Practice Address - Street 1:1350 TRAVIS BLVD UNIT 1507A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3440
Practice Address - Country:US
Practice Address - Phone:707-421-2020
Practice Address - Fax:707-425-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty