Provider Demographics
NPI:1922007483
Name:SUIVSKI, CHARLES (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SUIVSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4528
Mailing Address - Country:US
Mailing Address - Phone:772-283-4240
Mailing Address - Fax:772-221-2422
Practice Address - Street 1:2341 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4528
Practice Address - Country:US
Practice Address - Phone:772-283-4240
Practice Address - Fax:772-221-2422
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20220OtherBCBS PROVDER I.D.
FLU08351Medicare UPIN
FL20220OtherBCBS PROVDER I.D.
FL1236630001Medicare NSC