Provider Demographics
NPI:1174647747
Name:LEPAK, SUZY D (LDO)
Entity Type:Individual
Prefix:
First Name:SUZY
Middle Name:D
Last Name:LEPAK
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-2252
Mailing Address - Country:US
Mailing Address - Phone:727-522-2020
Mailing Address - Fax:727-522-2032
Practice Address - Street 1:5530 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-2252
Practice Address - Country:US
Practice Address - Phone:727-522-2020
Practice Address - Fax:727-522-2032
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL03331156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician