Provider Demographics
NPI:1073893285
Name:ROMEO, SUZANNE KATHRYN
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KATHRYN
Last Name:ROMEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E STOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7001
Mailing Address - Country:US
Mailing Address - Phone:805-925-2637
Mailing Address - Fax:805-925-3617
Practice Address - Street 1:425 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2805
Practice Address - Country:US
Practice Address - Phone:805-736-2020
Practice Address - Fax:805-737-1733
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA15368152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program