Provider Demographics
NPI:1346399060
Name:SOMMER, DARRY G (OD)
Entity Type:Individual
Prefix:
First Name:DARRY
Middle Name:G
Last Name:SOMMER
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 1:503 HAWTHORNE SC
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:847-816-1191
Mailing Address - Fax:847-816-1193
Practice Address - Street 1:503 HAWTHORNE SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-2680
Practice Address - Country:US
Practice Address - Phone:847-816-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL77824Medicare ID - Type Unspecified
ILU36727Medicare UPIN