Healthcare Provider Details

I. General information

NPI: 1518085315
Provider Name (Legal Business Name): SUMNER PRIMARY EYECARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WASHINGTON AVE
WASHINGTON MO
63090-3218
US

IV. Provider business mailing address

PO BOX 1907
WASHINGTON MO
63090-8907
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-2179
  • Fax: 636-239-9592
Mailing address:
  • Phone: 636-239-2179
  • Fax: 636-239-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN PATRICK SUMNER
Title or Position: PRESIDENT
Credential: OD
Phone: 636-239-2179