Provider Demographics
NPI:1225267677
Name:BRANT, SUZANNE MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:BRANT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MICHELLE
Other - Last Name:KARLQVIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
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 1:5116 S. BROADWAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113
Practice Address - Country:US
Practice Address - Phone:303-761-3285
Practice Address - Fax:303-761-3417
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist