Provider Demographics
NPI:1366464935
Name:BATTAGLIA, SUZANNE L (OD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:L
Last Name:BATTAGLIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:TOWNSEND-BATTAGLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2625 ELISHA AVE
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099
Mailing Address - Country:US
Mailing Address - Phone:847-746-1223
Mailing Address - Fax:847-746-1225
Practice Address - Street 1:2625 ELISHA AVE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:847-746-1223
Practice Address - Fax:847-746-1225
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL468316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U03064Medicare UPIN
931760Medicare ID - Type Unspecified