Provider Demographics
NPI:1669699682
Name:VALENTINE, SUZANNE M (LDO)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:VALENTINE
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 1:2168 TARRAGON RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7012
Mailing Address - Country:US
Mailing Address - Phone:561-641-7249
Mailing Address - Fax:
Practice Address - Street 1:9089 N MILITARY TRL STE 23
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-5992
Practice Address - Country:US
Practice Address - Phone:561-775-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4993156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician