Provider Demographics
NPI:1598943508
Name:CHARLES SUIVSKI OD PA
Entity Type:Organization
Organization Name:CHARLES SUIVSKI OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUIVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-286-9233
Mailing Address - Street 1:2341 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4528
Mailing Address - Country:US
Mailing Address - Phone:772-283-4240
Mailing Address - Fax:772-221-2422
Practice Address - Street 1:2341 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4528
Practice Address - Country:US
Practice Address - Phone:772-283-4240
Practice Address - Fax:772-221-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20220OtherBCBS PROVIDER I.D.
FL=========OtherCHAMPUS TRICARE PROV. ID
FL1236630001Medicare NSC
FL=========OtherCHAMPUS TRICARE PROV. ID
FLU08351Medicare UPIN