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General NPI Number Information
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NPI Number | 1689873481
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Entity Type | Organization
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Legal Business Name | JAMES R. SUMMERS O.D., P.A.
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 3408 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33803-4765
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Country | US
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Telephone | 863-646-4437
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Fax | 863-646-0210
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Provider Business Mailing Address
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Address Line | 3408 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33803-4765
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Country | US
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Telephone | 863-646-4437
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Fax | 863-646-0210
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES R SUMMERS
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Credential | O.D.
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Telephone | 863-646-4437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC2655
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License Number State | FL
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