Provider Demographics
NPI:1609122837
Name:ADKINS, SUZANNE RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:RENEE
Last Name:ADKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4240 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1713
Mailing Address - Country:US
Mailing Address - Phone:816-358-3600
Mailing Address - Fax:816-358-1887
Practice Address - Street 1:4240 BLUE RIDGE BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1754
Practice Address - Country:US
Practice Address - Phone:816-358-3600
Practice Address - Fax:816-358-1887
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019046784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2738Medicare UPIN