Provider Demographics
NPI:1548462013
Name:SUNSET EYE CARE P.C.
Entity type:Organization
Organization Name:SUNSET EYE CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:325-949-6697
Mailing Address - Street 1:4241 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE #108
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5687
Mailing Address - Country:US
Mailing Address - Phone:325-949-6697
Mailing Address - Fax:325-947-5077
Practice Address - Street 1:4241 SOUTHWEST BLVD
Practice Address - Street 2:SUITE #108
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5687
Practice Address - Country:US
Practice Address - Phone:325-949-6697
Practice Address - Fax:325-947-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5129TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145569301Medicaid
TX4267450001Medicare NSC
TX00122SMedicare PIN