Healthcare Provider Details

I. General information

NPI: 1780508606
Provider Name (Legal Business Name): CARSON DAYTON SUMMERS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 W 200 N
ROOSEVELT UT
84066-2834
US

IV. Provider business mailing address

165 W 200 N
ROOSEVELT UT
84066-2834
US

V. Phone/Fax

Practice location:
  • Phone: 435-722-2981
  • Fax:
Mailing address:
  • Phone: 435-722-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14300294-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: