Provider Demographics
NPI:1649900176
Name:SUSAN A DRISCOLL, O.D., LLC
Entity type:Organization
Organization Name:SUSAN A DRISCOLL, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-739-2123
Mailing Address - Street 1:717 SAINT DUNSTAN WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4851
Mailing Address - Country:US
Mailing Address - Phone:407-739-2123
Mailing Address - Fax:
Practice Address - Street 1:3272 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7549
Practice Address - Country:US
Practice Address - Phone:407-870-0051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUSAN DRISCOLL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty