Provider Demographics
NPI:1972783728
Name:SUMMERS, EVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:EVEN
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:EVAN
Other - Middle Name:
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:401 E BELL RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2300
Mailing Address - Country:US
Mailing Address - Phone:602-375-1041
Mailing Address - Fax:602-375-1041
Practice Address - Street 1:401 E BELL RD
Practice Address - Street 2:SUITE 24
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2300
Practice Address - Country:US
Practice Address - Phone:602-375-1041
Practice Address - Fax:602-375-1041
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist