Sundance Optical Clinic Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SUNDANCE OPTICAL CLINIC INC

Practice address

4201 N 16TH St Ste 160
Phoenix, AZ 85016-5348

Phone

(602) 277-5007

Fax

(602) 279-0557

NPI assigned

Nov 10, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Philip Kieran Clark, LDONPI 1295142362

Title

Owner

Phone

(602) 277-5007

Specialties & licenses 1

Addresses

Other names 1

• Sundance Optical Former legal business name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Philip Clark, LDO

  • Optician
  • Phoenix, AZ
  • NPI 1295142362
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1629786397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 N 16TH ST STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165348",
            "telephone_number": "602-277-5007",
            "fax_number": "602-279-0557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 N 16TH ST STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165348",
            "telephone_number": "602-277-5007",
            "fax_number": "602-279-0557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE OPTICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-10",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "KIERAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-277-5007",
        "authorized_official_credential": "LDO"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sundance Optical",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Suncrest Healthcare Center, LLC
• Suncrest Hospice Phoenix LLC
• Suncrest Palliative Care, LLC
• Micki B Sund, CNM
• Sundance Optical
• Tara Sue Sundem, NNP
• Shirazali G Sunderji, M.D.
• Sue Ann Sunderland, RN
• Gleniss Sundheimer
• Rebecca Helane Sunenshine, MD

• Eyewear Supplier in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Eyewear Supplier in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.