Provider Demographics
NPI:1871006338
Name:ACOSTA, SUZANNA ELENA (OD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNA
Middle Name:ELENA
Last Name:ACOSTA
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 1:8329 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2027
Mailing Address - Country:US
Mailing Address - Phone:219-923-2540
Mailing Address - Fax:
Practice Address - Street 1:9175 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2805
Practice Address - Country:US
Practice Address - Phone:219-836-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004074A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist