Provider Demographics
NPI:1174019160
Name:MAK, SUET MEI ANNIE (OD)
Entity Type:Individual
Prefix:DR
First Name:SUET MEI
Middle Name:ANNIE
Last Name:MAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:MAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1975 HIGH HOUSE RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8452
Practice Address - Country:US
Practice Address - Phone:919-461-0771
Practice Address - Fax:919-481-0645
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005134152W00000X
NC2607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist