Provider Demographics
NPI:1073841300
Name:LARRY D SUMNER, OD, PC
Entity Type:Organization
Organization Name:LARRY D SUMNER, OD, PC
Other - Org Name:SUMNER VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SUMNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-321-1606
Mailing Address - Street 1:3400 E BAYAUD AVE
Mailing Address - Street 2:SUITE 485
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2926
Mailing Address - Country:US
Mailing Address - Phone:303-321-1606
Mailing Address - Fax:303-321-0920
Practice Address - Street 1:3400 E BAYAUD AVE
Practice Address - Street 2:SUITE 485
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2926
Practice Address - Country:US
Practice Address - Phone:303-321-1606
Practice Address - Fax:303-321-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1582261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service