Provider Demographics
NPI:1669232690
Name:SUFFOLK, AMY MELISSA
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MELISSA
Last Name:SUFFOLK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 DAVE LYLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7939
Mailing Address - Country:US
Mailing Address - Phone:803-366-9404
Mailing Address - Fax:803-366-0251
Practice Address - Street 1:2377 DAVE LYLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-7939
Practice Address - Country:US
Practice Address - Phone:803-366-9404
Practice Address - Fax:803-366-0251
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OP1117A156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician