Provider Demographics
NPI:1437238912
Name:SUMMERTON, SUSAN JANETTE (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JANETTE
Last Name:SUMMERTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SUMMERTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD, CNS
Mailing Address - Street 1:8550 SCENIC HWY APT F
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7921
Mailing Address - Country:US
Mailing Address - Phone:239-438-8190
Mailing Address - Fax:
Practice Address - Street 1:2650 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7382
Practice Address - Country:US
Practice Address - Phone:850-542-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL919737OtherBLOCK
FL204312220OtherNVA
FL000E2604Medicare ID - Type Unspecified
FL204312220OtherNVA