Provider Demographics
NPI:1639521578
Name:SUMMERS, BETH (OD, MS)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 35TH ST
Mailing Address - Street 2:SUITE CF
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2519 35TH ST
Practice Address - Street 2:SUITE CF
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4870
Practice Address - Country:US
Practice Address - Phone:718-728-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-03
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist