Provider Demographics
NPI:1275292773
Name:SUNDERMAN DOWDALL
Entity Type:Organization
Organization Name:SUNDERMAN DOWDALL
Other - Org Name:NORTHERN KENTUCKY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWDALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-781-2000
Mailing Address - Street 1:92 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1729
Mailing Address - Country:US
Mailing Address - Phone:859-781-2000
Mailing Address - Fax:
Practice Address - Street 1:92 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1729
Practice Address - Country:US
Practice Address - Phone:859-781-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-12
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty