Provider Demographics
NPI:1396748620
Name:ZAMBERLAN, SUZANNE THERESE (OD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:THERESE
Last Name:ZAMBERLAN
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 1:13317 NE 12TH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2727
Mailing Address - Country:US
Mailing Address - Phone:360-573-3937
Mailing Address - Fax:360-574-3290
Practice Address - Street 1:13317 NE 12TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2727
Practice Address - Country:US
Practice Address - Phone:360-573-3937
Practice Address - Fax:360-574-3290
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2977AT152W00000X
WA3902TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MZ1181748OtherDEA NUMBER
V00389Medicare UPIN