Provider Demographics
NPI:1417140054
Name:BIRNBAUM, SUZANNE J (OD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:J
Last Name:BIRNBAUM
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 1:155 CRANES ROOST BLVD
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3468
Mailing Address - Country:US
Mailing Address - Phone:407-478-4800
Mailing Address - Fax:407-478-4805
Practice Address - Street 1:155 CRANES ROOST BLVD
Practice Address - Street 2:SUITE 1060
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3468
Practice Address - Country:US
Practice Address - Phone:407-478-4800
Practice Address - Fax:407-478-4805
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist