Provider Demographics
NPI:1912066119
Name:SIGHT AND SUN EYEWORKS LLC
Entity type:Organization
Organization Name:SIGHT AND SUN EYEWORKS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:8050 NAVARRE PKWY
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7550
Practice Address - Country:US
Practice Address - Phone:636-200-4393
Practice Address - Fax:850-939-8161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGHT AND SUN EYEWORKS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001650400Medicaid
FL97937OtherFLORIDA BLUE
FLBW904HMedicare PIN
FLBW904HMedicare PIN
FL620596800Medicaid
FL1200550001Medicare NSC