Provider Demographics
NPI:1346266673
Name:MARCUS-FREEMAN, SUSANNAH B (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:B
Last Name:MARCUS-FREEMAN
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 1:2038 SW 102ND TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3253
Mailing Address - Country:US
Mailing Address - Phone:352-332-2455
Mailing Address - Fax:352-271-4543
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:11C-1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-271-4543
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1415152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist