1396941902 NPI number — SUMNER FAMILY EYECARE P.L.L.C.

Table of content: (NPI 1396941902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396941902 NPI number — SUMNER FAMILY EYECARE P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMNER FAMILY EYECARE P.L.L.C.
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:
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:
1396941902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1022 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMNER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98390-1413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-826-2020
Provider Business Mailing Address Fax Number:
253-826-9200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1022 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-826-2020
Provider Business Practice Location Address Fax Number:
253-826-9200
Provider Enumeration Date:
06/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TOEPFER
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
253-826-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  602-735-861 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2033421 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".