1154503423 NPI number — SHERRI RAST OPTOMETRY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154503423 NPI number — SHERRI RAST OPTOMETRY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERRI RAST OPTOMETRY, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1154503423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7409 LAKE MICALA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78413-5823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-854-1460
Provider Business Mailing Address Fax Number:
361-993-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6646 S STAPLES ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78413-5425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-854-1460
Provider Business Practice Location Address Fax Number:
361-993-0900
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAST
Authorized Official First Name:
SHERRI
Authorized Official Middle Name:
CHRISTINE
Authorized Official Title or Position:
PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
361-854-1460

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5396TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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