Provider Demographics
NPI:1518073709
Name:SAWYER, SUSAN ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:SAWYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1613 S RIVERSIDE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-7701
Mailing Address - Country:US
Mailing Address - Phone:909-421-1022
Mailing Address - Fax:909-421-3932
Practice Address - Street 1:1613 S RIVERSIDE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7701
Practice Address - Country:US
Practice Address - Phone:909-421-1022
Practice Address - Fax:909-421-3932
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12002T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist