Provider Demographics
NPI:1336201722
Name:BOAS, SUZANNE O (OD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:O
Last Name:BOAS
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 1:577 W UWCHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1563
Mailing Address - Country:US
Mailing Address - Phone:610-363-2303
Mailing Address - Fax:
Practice Address - Street 1:577 W UWCHLAN AVE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1563
Practice Address - Country:US
Practice Address - Phone:610-363-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006675P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT72837Medicare UPIN
PA172876Medicare PIN