Provider Demographics
NPI:1255990594
Name:SUMMA, JOLENE LYNETTE
Entity type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:LYNETTE
Last Name:SUMMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 W HENRIETTA RD STE 31
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3543
Mailing Address - Country:US
Mailing Address - Phone:585-424-5970
Mailing Address - Fax:
Practice Address - Street 1:3333 W HENRIETTA RD STE 31
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3543
Practice Address - Country:US
Practice Address - Phone:585-424-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009013156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician