Provider Demographics
NPI:1184773905
Name:SUITER, DONNA L (OD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:SUITER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:L
Other - Last Name:SANZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4350 24TH AVE STE 634
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3853
Mailing Address - Country:US
Mailing Address - Phone:810-385-0888
Mailing Address - Fax:810-385-0832
Practice Address - Street 1:4350 24TH AVE
Practice Address - Street 2:STE 634
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3850
Practice Address - Country:US
Practice Address - Phone:810-385-0888
Practice Address - Fax:810-385-0832
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34040020Medicare ID - Type Unspecified
MIU80689Medicare UPIN