Sundance Optical Clinic INC
Eyewear Supplier (Equipment, not the service) in Phoenix, AZ. Organization (NPI-2).
Details
- NPI
- 1629786397
- Entity type
- Organization (NPI-2)
- Legal business name
- Sundance Optical Clinic INC
- Organization subpart
- No
- Enumeration date
- Nov 10, 2022
- Certification date
- Nov 10, 2022
- Last updated
- Nov 10, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 332H00000X | Eyewear Supplier (Equipment, not the service) | – | – | Yes |
Other names
- Sundance Optical (Former Legal Business Name)
Practice location
4201 N 16th St Ste 160Phoenix, AZ 85016-5348
Phone 602-277-5007 · Fax 602-279-0557
Mailing address
4201 N 16th St Ste 160Phoenix, AZ 85016-5348
Phone 602-277-5007 · Fax 602-279-0557
Authorized official
Philip Kieran Clark
Owner
6022775007
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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