Provider Demographics
NPI:1265559942
Name:VANDEUREN-HOBBS, SUSAN B (ABOC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:VANDEUREN-HOBBS
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 OLD US HWY 322
Mailing Address - Street 2:PO BOX 512
Mailing Address - City:REEDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17084-0512
Mailing Address - Country:US
Mailing Address - Phone:717-667-6023
Mailing Address - Fax:
Practice Address - Street 1:4704 OLD US HWY 322
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17084-0512
Practice Address - Country:US
Practice Address - Phone:717-667-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0914930001Medicare ID - Type Unspecified