Provider Demographics
NPI:1093752420
Name:YORKS, SUSAN E (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:YORKS
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 1:1678 EMPIRE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2130
Mailing Address - Country:US
Mailing Address - Phone:585-787-0500
Mailing Address - Fax:585-787-2066
Practice Address - Street 1:1678 EMPIRE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2130
Practice Address - Country:US
Practice Address - Phone:585-787-0500
Practice Address - Fax:585-787-2066
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005248-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
565140BMedicare PIN
565140AMedicare PIN
14184CMedicare PIN
NYU32389Medicare UPIN