Provider Demographics
NPI:1558340059
Name:LOCKLAND, SUSAN JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JEAN
Last Name:LOCKLAND
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 E SWEDESFORD RD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2333
Practice Address - Country:US
Practice Address - Phone:610-594-0800
Practice Address - Fax:610-594-0801
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012081047 0001Medicaid
PA1012081047 0001Medicaid