Provider Demographics
NPI:1619050044
Name:HALSTEAD, SUSAN E (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2628
Mailing Address - Country:US
Mailing Address - Phone:518-584-6111
Mailing Address - Fax:518-580-8589
Practice Address - Street 1:205 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2628
Practice Address - Country:US
Practice Address - Phone:518-584-6111
Practice Address - Fax:518-580-8589
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0069071156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician