MEDICARE: JAMES R. SUMMERS O.D., P.A.

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	OPC2655	FL

General Provider Information

NPI Number	:	1689873481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES R. SUMMERS O.D., P.A.

Provider Business Mailing Address
First Line	:	3408 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4765
Country	:	US
Telephone Number	:	863-646-4437
Fax Number	:	863-646-0210

Provider Business Practice Location Address
First Line	:	3408 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4765
Country	:	US
Telephone Number	:	863-646-4437
Fax Number	:	863-646-0210

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES R SUMMERS
Credential	:	O.D.
Telephone Number	:	863-646-4437

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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