Provider Demographics
NPI:1154332203
Name:SUMMERS, SETH JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:JAMES
Last Name:SUMMERS
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 1:4036 1/2 DUTCHMANS LANE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-894-0322
Mailing Address - Fax:502-657-5046
Practice Address - Street 1:4036 1/2 DUTCHMANS LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-894-0322
Practice Address - Fax:502-657-5046
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003383A152W00000X
KY1663DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001642Medicaid
IN235270Medicare PIN
KY00332001Medicare PIN
V08933Medicare UPIN