Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1582 | CO |
NPI | 1245255223 |
---|---|
Provider Name | Dr. Larry Douglas Sumner |
First Address | Denver, CO 80209-2926 |
Second Address | Denver, CO 80209-2926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 19/12/2012 |