1396995635 NPI number — DR THOMAS P SUTTON OPTOMETRIST PC

Table of content: (NPI 1396995635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396995635 NPI number — DR THOMAS P SUTTON OPTOMETRIST PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR THOMAS P SUTTON OPTOMETRIST PC
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:
1396995635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2111 N WEBER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80907-6929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-632-5192
Provider Business Mailing Address Fax Number:
719-632-6552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2110 HOLLOW BROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80918-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-599-7111
Provider Business Practice Location Address Fax Number:
719-598-1592
Provider Enumeration Date:
09/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TYLER
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
719-632-5192

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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