Provider Demographics
NPI:1003986522
Name:SOMMER, BRIAN C (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:SOMMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1817
Mailing Address - Country:US
Mailing Address - Phone:309-263-8611
Mailing Address - Fax:309-263-8926
Practice Address - Street 1:417 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1817
Practice Address - Country:US
Practice Address - Phone:309-263-8611
Practice Address - Fax:309-263-8926
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410046605OtherPALMETTO GBA RAILROAD MEDICARE
4429890001Medicare NSC
ILIL6829001Medicare UPIN