Provider Demographics
NPI:1225266240
Name:DR. SUSAN G. RODGIN
Entity Type:Organization
Organization Name:DR. SUSAN G. RODGIN
Other - Org Name:COCHITUATE EYE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:RODGIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-651-3887
Mailing Address - Street 1:33 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-5015
Mailing Address - Country:US
Mailing Address - Phone:508-651-3887
Mailing Address - Fax:508-651-3888
Practice Address - Street 1:33 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-5015
Practice Address - Country:US
Practice Address - Phone:508-651-3887
Practice Address - Fax:508-651-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3167261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0131200001Medicare NSC