1003008160 NPI number — STERLING OPTICAL#541

Table of content: (NPI 1003008160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003008160 NPI number — STERLING OPTICAL#541

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STERLING OPTICAL#541
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FLOW OPTICAL INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003008160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MILLS CIR
Provider Second Line Business Mailing Address:
1016
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91764-5207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-481-1083
Provider Business Mailing Address Fax Number:
909-484-2060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MILLS CIR
Provider Second Line Business Practice Location Address:
1016
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91764-5207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-481-1083
Provider Business Practice Location Address Fax Number:
909-484-2060
Provider Enumeration Date:
08/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
909-481-1083

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5677 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)