Provider Demographics
NPI:1194839209
Name:RODGIN, SUSAN G (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:G
Last Name:RODGIN
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 1:33 MAIN ST.
Mailing Address - Street 2:P.O. BOX 5121
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778
Mailing Address - Country:US
Mailing Address - Phone:508-651-3887
Mailing Address - Fax:
Practice Address - Street 1:33 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778
Practice Address - Country:US
Practice Address - Phone:508-651-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264944171100000X
MA3167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No171100000XOther Service ProvidersAcupuncturist