Provider Demographics
NPI:1215126545
Name:TATE ENTERPRISES OF SUMNER PLACE INC.
Entity type:Organization
Organization Name:TATE ENTERPRISES OF SUMNER PLACE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:301-229-3775
Mailing Address - Street 1:4611 SANGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2503
Mailing Address - Country:US
Mailing Address - Phone:301-229-3775
Mailing Address - Fax:301-263-1223
Practice Address - Street 1:4611 SANGAMORE RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2503
Practice Address - Country:US
Practice Address - Phone:301-229-3775
Practice Address - Fax:301-263-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty