Provider Demographics
NPI:1235190612
Name:KURLAND, SUSAN A (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:KURLAND
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 1:23250 CHAGRIN BLVD
Mailing Address - Street 2:BLD #5 STE 440
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-514-1864
Mailing Address - Fax:216-514-1867
Practice Address - Street 1:23250 CHAGRIN BLVD
Practice Address - Street 2:BLD #5 STE 440
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-514-1864
Practice Address - Fax:216-514-1867
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3745T529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0915442Medicaid
341711241OtherCORPEIN
341711241OtherCORPEIN
KU0723541Medicare ID - Type Unspecified