Provider Demographics
NPI:1922332543
Name:CORBITT, SUZANNE GRANTHAM (OD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:GRANTHAM
Last Name:CORBITT
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 1:55 TIMBER LN
Mailing Address - Street 2:OPHTHALMIC CONSULTANTS OF VERMONT
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5201
Mailing Address - Country:US
Mailing Address - Phone:802-864-2010
Mailing Address - Fax:
Practice Address - Street 1:55 TIMBER LN
Practice Address - Street 2:OPHTHALMIC CONSULTANTS OF VERMONT
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5201
Practice Address - Country:US
Practice Address - Phone:802-864-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0053208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist