Provider Demographics
NPI:1740234376
Name:SMITH, SUZANNE RENEE (OD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:RENEE
Other - Last Name:BUHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-234-2616
Mailing Address - Fax:319-234-1939
Practice Address - Street 1:909 E SAN MARNAN DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5611
Practice Address - Country:US
Practice Address - Phone:319-234-2616
Practice Address - Fax:319-234-1939
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421417307C8OtherJOHN DEERE HEALTH INS PLA
IA48266OtherWELLMARK INS PLAN
IA1154146Medicaid
IA421417307C8OtherJOHN DEERE HEALTH INS PLA
IA48266OtherWELLMARK INS PLAN