Provider Demographics
NPI:1871654855
Name:MICHAELS, SUZANN LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:SUZANN
Middle Name:LYNN
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8331 ALVARADO DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-6106
Mailing Address - Country:US
Mailing Address - Phone:714-536-9200
Mailing Address - Fax:714-839-9635
Practice Address - Street 1:748 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-2337
Practice Address - Country:US
Practice Address - Phone:714-839-7534
Practice Address - Fax:714-839-9635
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT10543TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0105430Medicaid
CAU94418Medicare UPIN