Provider Demographics
NPI:1952346819
Name:SUMMIT EYE CARE, PLLC
Entity Type:Organization
Organization Name:SUMMIT EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-783-4114
Mailing Address - Street 1:568 FOOTHILL DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-9607
Mailing Address - Country:US
Mailing Address - Phone:435-783-4114
Mailing Address - Fax:
Practice Address - Street 1:568 FOOTHILL DR
Practice Address - Street 2:SUITE 5
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-9607
Practice Address - Country:US
Practice Address - Phone:435-783-4114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5959399-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1508839770Medicare UPIN