Provider Demographics
NPI:1033236047
Name:SLOAN, SUSAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:SLOAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7502
Mailing Address - Country:US
Mailing Address - Phone:941-365-2040
Mailing Address - Fax:941-366-6480
Practice Address - Street 1:500 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7502
Practice Address - Country:US
Practice Address - Phone:941-365-2040
Practice Address - Fax:941-366-6480
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist