Provider Demographics
NPI:1659344216
Name:WARD, SUZANNE M (OD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:WARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 PARK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2346
Mailing Address - Country:US
Mailing Address - Phone:978-276-1111
Mailing Address - Fax:
Practice Address - Street 1:162 PARK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2346
Practice Address - Country:US
Practice Address - Phone:978-276-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3666152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW16226OtherBLUE CROSS
U28401Medicare UPIN
MA453658Medicare ID - Type Unspecified