Provider Demographics
NPI:1811044027
Name:VROUVAS, SUSY BALLA (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSY
Middle Name:BALLA
Last Name:VROUVAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUSY
Other - Middle Name:
Other - Last Name:BALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1635 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3036
Mailing Address - Country:US
Mailing Address - Phone:415-833-3939
Mailing Address - Fax:415-833-2609
Practice Address - Street 1:1635 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3036
Practice Address - Country:US
Practice Address - Phone:415-833-3939
Practice Address - Fax:415-833-2609
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7411T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist