Provider Demographics
NPI:1376537183
Name:HOUCHIN, SUSAN E (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:HOUCHIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:BANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1295 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2982
Mailing Address - Country:US
Mailing Address - Phone:858-248-2589
Mailing Address - Fax:
Practice Address - Street 1:1295 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2982
Practice Address - Country:US
Practice Address - Phone:858-248-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002870A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200393740Medicaid
IN200393740Medicaid
IN4585580001Medicare NSC
IN197260AMedicare PIN