Provider Demographics
NPI:1063084101
Name:SUMNER, AMY E W (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E W
Last Name:SUMNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:WHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2804 MEMPHIS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4208
Mailing Address - Country:US
Mailing Address - Phone:410-920-9012
Mailing Address - Fax:
Practice Address - Street 1:1420 WALNUT ST STE 600
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4005
Practice Address - Country:US
Practice Address - Phone:215-735-6300
Practice Address - Fax:215-735-2244
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003851152W00000X
NJ27OA00706900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist