Healthcare Provider Details

I. General information

NPI: 1396941902
Provider Name (Legal Business Name): SUMNER FAMILY EYECARE P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 MAIN ST
SUMNER WA
98390-1413
US

IV. Provider business mailing address

1022 MAIN ST
SUMNER WA
98390-1413
US

V. Phone/Fax

Practice location:
  • Phone: 253-826-2020
  • Fax: 253-826-9200
Mailing address:
  • Phone: 253-826-2020
  • Fax: 253-826-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number602-735-861
License Number StateWA

VIII. Authorized Official

Name: DR. LAURA ANN TOEPFER
Title or Position: MANAGER
Credential: O.D.
Phone: 253-826-2020