Provider Demographics
NPI:1720002918
Name:CSONKA, SUSAN NIEVES (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:NIEVES
Last Name:CSONKA
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 1:6013 BABCOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2502
Mailing Address - Country:US
Mailing Address - Phone:412-364-4090
Mailing Address - Fax:412-364-7990
Practice Address - Street 1:6013 BABCOCK BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2502
Practice Address - Country:US
Practice Address - Phone:412-364-4090
Practice Address - Fax:412-364-7990
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001203152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU07729Medicare UPIN
PA0664580001Medicare NSC