1518085315 NPI number — SUMNER PRIMARY EYECARE, P.C.

Table of content: (NPI 1518085315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518085315 NPI number — SUMNER PRIMARY EYECARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMNER PRIMARY EYECARE, P.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:
1518085315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1907
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63090-8907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-239-2179
Provider Business Mailing Address Fax Number:
636-239-9592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63090-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-239-2179
Provider Business Practice Location Address Fax Number:
636-239-9592
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUMNER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
636-239-2179

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0422810001 . This is a "DMERC - NORIDIAN ADMINIST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 507272805 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com