1982615449 NPI number — DR. SUZANNE EMERITA ANDERSON O.D.

Table of content: DR. SUZANNE EMERITA ANDERSON O.D. (NPI 1982615449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982615449 NPI number — DR. SUZANNE EMERITA ANDERSON O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
SUZANNE
Provider Middle Name:
EMERITA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GENTLES
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
NADINE EMERITA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982615449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8010 DOVE FLIGHT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-682-3773
Provider Business Mailing Address Fax Number:
210-682-3773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 NW LOOP 410
Provider Second Line Business Practice Location Address:
SEARS BUILDING
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78238-3824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-682-3773
Provider Business Practice Location Address Fax Number:
210-682-3773
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4650TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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