Provider Demographics
NPI:1710936539
Name:MICHAEL SUMSION MD DBA RIVERSIDE EYECARE PROFESSIONALS
Entity Type:Organization
Organization Name:MICHAEL SUMSION MD DBA RIVERSIDE EYECARE PROFESSIONALS
Other - Org Name:RIVERSIDE EYECARE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-244-2273
Mailing Address - Street 1:2801 PARK MARINA DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2822
Mailing Address - Country:US
Mailing Address - Phone:530-244-2273
Mailing Address - Fax:530-244-2708
Practice Address - Street 1:2801 PARK MARINA DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2822
Practice Address - Country:US
Practice Address - Phone:530-244-2273
Practice Address - Fax:530-244-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080870Medicaid
CAZZZ55925ZOtherBLUE SHIELD
CAGR0080870Medicaid
CA========= G68804OtherBLUE CROSS