Provider Demographics
NPI:1023193026
Name:SUMMERFIELD VISION CARE LLC
Entity Type:Organization
Organization Name:SUMMERFIELD VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SUMMERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-787-7409
Mailing Address - Street 1:47403 QUEENS COVE CIR
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-4142
Mailing Address - Country:US
Mailing Address - Phone:507-643-6978
Mailing Address - Fax:
Practice Address - Street 1:201 SAND LAKE ROAD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650
Practice Address - Country:US
Practice Address - Phone:608-787-7409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI 1950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty