Provider Demographics
NPI:1386635050
Name:PERDUE, SUSAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:PERDUE
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 1:8470 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-9461
Mailing Address - Country:US
Mailing Address - Phone:989-624-2020
Mailing Address - Fax:989-624-6257
Practice Address - Street 1:8470 MAIN ST
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-9704
Practice Address - Country:US
Practice Address - Phone:989-624-2020
Practice Address - Fax:989-624-6257
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0982400OtherHEALTHPLUS
MI1891846812OtherDMERC
MI4743837Medicaid
MI900G311760OtherBCBSM
MI1891846812OtherDMERC
MIT96930Medicare UPIN
MI4743837Medicaid