MEDICARE: TATE ENTERPRISES OF SUMNER PLACE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1215126545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TATE ENTERPRISES OF SUMNER PLACE INC.

Provider Business Mailing Address
First Line	:	4611 SANGAMORE RD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20816-2503
Country	:	US
Telephone Number	:	301-229-3775
Fax Number	:	301-263-1223

Provider Business Practice Location Address
First Line	:	4611 SANGAMORE RD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20816-2503
Country	:	US
Telephone Number	:	301-229-3775
Fax Number	:	301-263-1223

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SAMUEL GEORGE TATE
Credential	:	OPTICIAN
Telephone Number	:	301-229-3775

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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