Provider Demographics
NPI:1558400655
Name:KILGO, SUSANNE SYDOW (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:SYDOW
Last Name:KILGO
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 1:2 WALDEN RIDGE DR STE 50
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8598
Mailing Address - Country:US
Mailing Address - Phone:828-676-3260
Mailing Address - Fax:828-676-3258
Practice Address - Street 1:2 WALDEN RIDGE DR STE 50
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-676-3260
Practice Address - Fax:828-676-3258
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC246353DMedicare ID - Type Unspecified
NCT64894Medicare UPIN