1154631299 NPI number — RICHARD A. SYLVESTER M.A.T., O.D., P.A

Table of content: (NPI 1154631299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154631299 NPI number — RICHARD A. SYLVESTER M.A.T., O.D., P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD A. SYLVESTER M.A.T., O.D., P.A
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:
CRYSTAL CLEAR IMAGE OPTICAL BOUTIQUE
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:
1154631299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 LEGACY DR
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-0813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-334-9944
Provider Business Mailing Address Fax Number:
972-334-9011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 LEGACY DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-0813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-334-9944
Provider Business Practice Location Address Fax Number:
972-334-9011
Provider Enumeration Date:
10/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SYLVESTER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-334-9944

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  T5346 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: T5346 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , with the licence number: T5346 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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