Provider Demographics
NPI:1245255223
Name:SUMNER, LARRY DOUGLAS (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DOUGLAS
Last Name:SUMNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3400 E BAYAUD AVE
Mailing Address - Street 2:SUITE 485
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2926
Mailing Address - Country:US
Mailing Address - Phone:303-321-1606
Mailing Address - Fax:303-321-0920
Practice Address - Street 1:3400 E BAYAUD AVE
Practice Address - Street 2:SUITE 485
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2926
Practice Address - Country:US
Practice Address - Phone:303-321-1606
Practice Address - Fax:303-321-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1582152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44033Medicare PIN