Provider Demographics
NPI:1306335435
Name:SUMNICHT, ANDREW JOHN (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:SUMNICHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21827 76TH AVE W STE 102
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7981
Mailing Address - Country:US
Mailing Address - Phone:425-778-2500
Mailing Address - Fax:
Practice Address - Street 1:21827 76TH AVE W STE 102
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7981
Practice Address - Country:US
Practice Address - Phone:425-778-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61289493207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program