MEDICARE: LARRY D SUMNER, OD, PC

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	261QH0100X	Health Service Clinic/Center	1582	CO

General Provider Information

NPI Number	:	1073841300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY D SUMNER, OD, PC

Provider Business Mailing Address
First Line	:	3400 E BAYAUD AVE
Second Line	:	SUITE 485
City	:	DENVER
State	:	CO
Zip	:	80209-2926
Country	:	US
Telephone Number	:	303-321-1606
Fax Number	:	303-321-0920

Provider Business Practice Location Address
First Line	:	3400 E BAYAUD AVE
Second Line	:	SUITE 485
City	:	DENVER
State	:	CO
Zip	:	80209-2926
Country	:	US
Telephone Number	:	303-321-1606
Fax Number	:	303-321-0920

Authorized Official
Title or Position	:	PRESIDENT/OPTOMETRIST
Name	:	DR. LARRY DOUGLAS SUMNER
Credential	:	O.D.
Telephone Number	:	303-321-1606

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	11/24/2009

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