Provider Demographics
NPI:1326614272
Name:SUMMERHAYS, PRESTON TODD (OD)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:TODD
Last Name:SUMMERHAYS
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 1:10245 W DALEY LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2737
Mailing Address - Country:US
Mailing Address - Phone:801-654-3341
Mailing Address - Fax:
Practice Address - Street 1:13945 W GRAND AVE # A101
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2437
Practice Address - Country:US
Practice Address - Phone:623-931-2943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002487152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist