Provider Demographics
NPI:1518993583
Name:RICH, SUZANNAH R (OD)
Entity Type:Individual
Prefix:
First Name:SUZANNAH
Middle Name:R
Last Name:RICH
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 1:1024 N MAIN ST
Mailing Address - Street 2:INSIDE WAL-MART VISION CENTER
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2311
Mailing Address - Country:US
Mailing Address - Phone:859-881-5444
Mailing Address - Fax:
Practice Address - Street 1:4051 NICHOLASVILLE RD
Practice Address - Street 2:INSIDE WAL-MART VISION CTR
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-4432
Practice Address - Country:US
Practice Address - Phone:859-272-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1355DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000362600OtherBLUE CROSS BLUE SHIELD
KY77000271Medicaid
KY77000271Medicaid
KY0960202Medicare PIN