Provider Demographics
NPI:1457442790
Name:PROLEIKA, SUZANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:PROLEIKA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:PROLEIKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1817 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4338
Mailing Address - Country:US
Mailing Address - Phone:570-883-9696
Mailing Address - Fax:570-654-3739
Practice Address - Street 1:390 ROUTE 315 HWY
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3903
Practice Address - Country:US
Practice Address - Phone:570-883-9696
Practice Address - Fax:570-654-3739
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000862152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5888543OtherAETNA PPO
925107OtherBLOCK VISION
080349OtherFIRST PRIORITY
37443OtherAVESIS
396812OtherNVA
4141OtherDAVIS
PA001753849Medicaid
13315OtherGEISINGER
27739OtherMES
196096OtherCLARITY VISION
351435OtherHEALTH ASSURANCE
152877OtherCOLE
2018248OtherAETNA HMO
8314OtherSPECTERA
080349OtherFIRST PRIORITY
U44825Medicare UPIN