Provider Demographics
NPI:1447413372
Name:SUNNY VISION CORP
Entity type:Organization
Organization Name:SUNNY VISION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-592-6241
Mailing Address - Street 1:2500 LEMOINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6232
Mailing Address - Country:US
Mailing Address - Phone:201-592-6241
Mailing Address - Fax:201-592-1184
Practice Address - Street 1:2500 LEMOINE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6232
Practice Address - Country:US
Practice Address - Phone:201-592-6241
Practice Address - Fax:201-592-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD-1240335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5595890001Medicare NSC