Provider Demographics
NPI:1336144476
Name:COVEY, SUSAN C (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:COVEY
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 1:113 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-1348
Mailing Address - Country:US
Mailing Address - Phone:814-355-2522
Mailing Address - Fax:814-355-9261
Practice Address - Street 1:113 S SPRING ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1348
Practice Address - Country:US
Practice Address - Phone:814-355-2522
Practice Address - Fax:814-355-9261
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT72356Medicare UPIN
PA0241670001Medicare NSC
PA006945Medicare PIN