Provider Demographics
NPI:1780853317
Name:SUE E. VAN DOOTINGH OD
Entity Type:Organization
Organization Name:SUE E. VAN DOOTINGH OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAN DOOTINGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-732-2828
Mailing Address - Street 1:820 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2416
Mailing Address - Country:US
Mailing Address - Phone:419-732-2828
Mailing Address - Fax:419-734-5914
Practice Address - Street 1:820 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2416
Practice Address - Country:US
Practice Address - Phone:419-732-2828
Practice Address - Fax:419-734-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0548310001Medicare NSC