Provider Demographics
NPI:1609925163
Name:DR THOMAS P SUTTON OPTOMETRIST P C
Entity Type:Organization
Organization Name:DR THOMAS P SUTTON OPTOMETRIST P C
Other - Org Name:THOMAS P. SUTTON, O.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-632-5192
Mailing Address - Street 1:2111 N WEBER ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6929
Mailing Address - Country:US
Mailing Address - Phone:719-632-5192
Mailing Address - Fax:719-632-6552
Practice Address - Street 1:2111 N WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6929
Practice Address - Country:US
Practice Address - Phone:719-632-5192
Practice Address - Fax:719-632-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1075332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT95496Medicare UPIN
COP01079084Medicare PIN
CO5851190001Medicare NSC
CODS9410Medicare PIN