Provider Demographics
NPI:1487165429
Name:SUNGLASS CITY INC
Entity type:Organization
Organization Name:SUNGLASS CITY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAMAJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-456-7297
Mailing Address - Street 1:623 SAN ANSELMO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2615
Mailing Address - Country:US
Mailing Address - Phone:415-456-7297
Mailing Address - Fax:415-456-3644
Practice Address - Street 1:623 SAN ANSELMO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2615
Practice Address - Country:US
Practice Address - Phone:415-456-7297
Practice Address - Fax:415-456-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46890156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty