Provider Demographics
NPI:1215029285
Name:SUFFOLK, RALPH DANIEL III (OD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:DANIEL
Last Name:SUFFOLK
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5399 W GENESEE ST
Mailing Address - Street 2:WALMART VISION CENTER 2581
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2265
Mailing Address - Country:US
Mailing Address - Phone:315-468-2745
Mailing Address - Fax:315-468-2786
Practice Address - Street 1:5399 W GENESEE ST
Practice Address - Street 2:WALMART VISION CENTER 2581
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2265
Practice Address - Country:US
Practice Address - Phone:315-468-2745
Practice Address - Fax:315-468-2786
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUOO4200-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA1101Medicare PIN
NYU47775Medicare UPIN
NY53880BMedicare ID - Type Unspecified