Provider Demographics
NPI:1902188501
Name:LARA, SUMMER GIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:GIANA
Last Name:LARA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 N TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:575-523-2020
Mailing Address - Fax:
Practice Address - Street 1:2810 N TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8230
Practice Address - Country:US
Practice Address - Phone:575-523-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM695152WP0200X
NC2289152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM695OtherNEW MEXICO OPTOMETRY LICENSE
CA14302OtherCALIFORNIA OPTOMETRY LICENSE #