MEDICARE: DR. LARRY DOUGLAS SUMNER O.D.

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	152WC0802X	Corneal and Contact Management Optometrist	1582	CO

General Provider Information

NPI Number	:	1245255223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY DOUGLAS SUMNER O.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	12/19/2012

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