Provider Demographics
NPI:1679866958
Name:SUITT, SACH M (LDO)
Entity Type:Individual
Prefix:
First Name:SACH
Middle Name:M
Last Name:SUITT
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 E TUDOR RD STE 8
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1200
Mailing Address - Country:US
Mailing Address - Phone:800-478-5510
Mailing Address - Fax:800-637-4104
Practice Address - Street 1:3561 E TUDOR RD STE 8
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1200
Practice Address - Country:US
Practice Address - Phone:800-478-5510
Practice Address - Fax:800-637-4104
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK278156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK278OtherSTATEOF ALASKA LICENSED DISPENSING OPTICIAN