Provider Demographics
NPI:1598730731
Name:SUZUKI, JO ANNE S (OD)
Entity Type:Individual
Prefix:DR
First Name:JO ANNE
Middle Name:S
Last Name:SUZUKI
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 1:1111 KENNEDY PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1266
Mailing Address - Country:US
Mailing Address - Phone:530-753-2020
Mailing Address - Fax:530-753-7441
Practice Address - Street 1:1111 KENNEDY PL
Practice Address - Street 2:SUITE 1
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1266
Practice Address - Country:US
Practice Address - Phone:530-753-2020
Practice Address - Fax:530-753-7441
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA09368T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0093680Medicaid
CACA09368TOtherOPTOMETRY LICENSE #
CA68-0391685OtherEIN
CACA09368TOtherOPTOMETRY LICENSE #
CAU11092Medicare UPIN