Provider Demographics
NPI:1568869881
Name:SUMRALL, JESSICA (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 FORT RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:GOODFELLOW AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76908-4901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4450 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5611
Practice Address - Country:US
Practice Address - Phone:325-481-2286
Practice Address - Fax:325-481-2028
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9523T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist