Provider Demographics
NPI:1629118443
Name:BARBER-ROSENGRANT, SUSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:BARBER-ROSENGRANT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:B
Other - Last Name:ROSENGRANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:10 TOWNE PLZ
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-9518
Mailing Address - Country:US
Mailing Address - Phone:570-836-1900
Mailing Address - Fax:570-836-1900
Practice Address - Street 1:10 TOWNE PLZ
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-9518
Practice Address - Country:US
Practice Address - Phone:570-836-1900
Practice Address - Fax:570-836-1900
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-6849P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012178720002Medicaid
PA0131400001Medicare NSC
PAUO5776Medicare UPIN
PABA631393Medicare PIN