Provider Demographics
NPI:1497803043
Name:SUMMERS OPTICAL, INC.
Entity Type:Organization
Organization Name:SUMMERS OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-886-8928
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0704
Mailing Address - Country:US
Mailing Address - Phone:270-886-8928
Mailing Address - Fax:270-886-4773
Practice Address - Street 1:209 W 15TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2035
Practice Address - Country:US
Practice Address - Phone:270-886-8928
Practice Address - Fax:270-886-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY32417OtherAVESIS
KY52800968Medicaid
KY000000215307OtherANTHEM BCBS
KYKY0683OtherEYEMED
KY32417OtherAVESIS