Provider Demographics
NPI:1205400819
Name:SUTTON, DARE (OD)
Entity Type:Individual
Prefix:DR
First Name:DARE
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:EDDYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42038-8139
Mailing Address - Country:US
Mailing Address - Phone:270-601-1042
Mailing Address - Fax:
Practice Address - Street 1:4216 SUMMIT PLAZA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-8106
Practice Address - Country:US
Practice Address - Phone:502-327-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004263A152W00000X
KY2249DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist