MEDICARE: BRIAN PATRICK SUMNER OD.

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	152W00000X	Optometrist	TO2351	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2202100	OTHER	MO	UNITED HEALTH CARE
2	233006	OTHER	MO	GROUP HEALTH PLAN
3	122489	OTHER	MO	HEALTHLINK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	32218	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1588667992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN PATRICK SUMNER OD.

Provider Business Mailing Address
First Line	:	320 WASHINGTON AVE
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-3218
Country	:	US
Telephone Number	:	636-239-2179
Fax Number	:	636-239-9592

Provider Business Practice Location Address
First Line	:	320 WASHINGTON AVE
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-3218
Country	:	US
Telephone Number	:	636-239-2179
Fax Number	:	636-239-9592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/08/2020

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