Provider Demographics
NPI:1922623461
Name:SURIANO, JOSEPH GENNARO (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GENNARO
Last Name:SURIANO
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 1:6121 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4510
Mailing Address - Country:US
Mailing Address - Phone:630-632-5072
Mailing Address - Fax:
Practice Address - Street 1:5709 JOHNS RD STE 1209
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4315
Practice Address - Country:US
Practice Address - Phone:813-885-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist