Provider Demographics
NPI:1417009002
Name:BAYLUS, SUSAN LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:BAYLUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:930 COMMONWEALTH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1274
Mailing Address - Country:US
Mailing Address - Phone:617-262-2020
Mailing Address - Fax:617-587-5514
Practice Address - Street 1:930 COMMONWEALTH AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1274
Practice Address - Country:US
Practice Address - Phone:617-262-2020
Practice Address - Fax:617-587-5514
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3487152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1525174Medicaid
MACA1182Medicare PIN
MA1525174Medicaid