Provider Demographics
NPI: | 1386918860 |
---|---|
Name: | SUNNY M. FIELD, O.D., F.A.A.O., P.A. |
Entity type: | Organization |
Organization Name: | SUNNY M. FIELD, O.D., F.A.A.O., P.A. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OPTOMETRIST/OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SUNNY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FIELD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 310-592-3161 |
Mailing Address - Street 1: | 153 YORKSHIRE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | HEATH |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75032-6648 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1225 STATE HIGHWAY 276 |
Practice Address - Street 2: | |
Practice Address - City: | ROCKWALL |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75032-9376 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-772-1613 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-03-01 |
Last Update Date: | 2012-03-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 7304T | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |