Provider Demographics
NPI:1578570917
Name:SOMMERS, MICHAEL NORMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NORMAN
Last Name:SOMMERS
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 1:1800 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-4208
Mailing Address - Country:US
Mailing Address - Phone:417-533-5466
Mailing Address - Fax:417-533-5480
Practice Address - Street 1:1800 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-4208
Practice Address - Country:US
Practice Address - Phone:417-533-5466
Practice Address - Fax:417-533-5480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU02199Medicare UPIN