Provider Demographics
NPI:1518085315
Name:SUMNER PRIMARY EYECARE, P.C.
Entity Type:Organization
Organization Name:SUMNER PRIMARY EYECARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SUMNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-239-2179
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-8907
Mailing Address - Country:US
Mailing Address - Phone:636-239-2179
Mailing Address - Fax:636-239-9592
Practice Address - Street 1:320 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3218
Practice Address - Country:US
Practice Address - Phone:636-239-2179
Practice Address - Fax:636-239-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
MO3058152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0422810001OtherDMERC - NORIDIAN ADMINIST
MO507272805Medicaid
MOT42542Medicare UPIN
MOU38202Medicare UPIN
MO507272805Medicaid