Provider Demographics
NPI:1780664706
Name:SUMMERS, MARY GRACE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:GRACE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8045 CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5977
Mailing Address - Country:US
Mailing Address - Phone:901-758-1384
Mailing Address - Fax:901-758-1394
Practice Address - Street 1:8045 CLUB PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5977
Practice Address - Country:US
Practice Address - Phone:901-758-1384
Practice Address - Fax:901-758-1394
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1429152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4092194OtherBLUE CROSS BLUE SHIELD
TN2240091OtherUNITED HEALTH CARE
TN2240091OtherUNITED HEALTH CARE