Provider Demographics
NPI:1891706412
Name:BULLANO, SUSAN KRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KRISTINE
Last Name:BULLANO
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 1:13385 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-8358
Mailing Address - Country:US
Mailing Address - Phone:816-390-8644
Mailing Address - Fax:
Practice Address - Street 1:6120 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3333
Practice Address - Country:US
Practice Address - Phone:913-262-3937
Practice Address - Fax:913-262-3942
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000F023Medicare PIN
KSKA2408002Medicare PIN