Provider Demographics
NPI:1497558639
Name:FELIX, SUSAN (LDO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FELIX
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 E TUCSON MARKETPLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-6508
Mailing Address - Country:US
Mailing Address - Phone:520-917-0319
Mailing Address - Fax:520-622-2843
Practice Address - Street 1:1260 E TUCSON MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6508
Practice Address - Country:US
Practice Address - Phone:520-917-0319
Practice Address - Fax:520-622-2843
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLDO-003256156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician