Provider Demographics
NPI:1093800450
Name:BELLISSIMO, SUZANNE MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARY
Last Name:BELLISSIMO
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:315 WILD WIND DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15102
Mailing Address - Country:US
Mailing Address - Phone:724-379-8264
Mailing Address - Fax:
Practice Address - Street 1:100 SARA WAY
Practice Address - Street 2:ROSTRAVER SQUARE
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012
Practice Address - Country:US
Practice Address - Phone:724-929-2481
Practice Address - Fax:724-929-2584
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist