Provider Demographics
NPI:1598842122
Name:MISIEWICZ, SUZANNE M
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:MISIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 VILLAGE PL
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4132
Mailing Address - Country:US
Mailing Address - Phone:630-323-1615
Mailing Address - Fax:630-323-1615
Practice Address - Street 1:44 VILLAGE PL
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4132
Practice Address - Country:US
Practice Address - Phone:630-323-1615
Practice Address - Fax:630-323-1615
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2389-5853156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0818530001Medicare ID - Type UnspecifiedMEDICARE SUPPLIER NUMBER