Provider Demographics
NPI:1982760575
Name:GREGG S SUNNER, O.D., P.C.
Entity Type:Organization
Organization Name:GREGG S SUNNER, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-964-7355
Mailing Address - Street 1:111 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1754
Mailing Address - Country:US
Mailing Address - Phone:515-964-7355
Mailing Address - Fax:515-964-8413
Practice Address - Street 1:111 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1754
Practice Address - Country:US
Practice Address - Phone:515-964-7355
Practice Address - Fax:515-964-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0151120001Medicare NSC
IA02889Medicare ID - Type Unspecified