Provider Demographics
NPI:1720830524
Name:SEBESTYEN, SUSANA (OD, FAAO, CEDH, IMD)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:SEBESTYEN
Suffix:
Gender:F
Credentials:OD, FAAO, CEDH, IMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 WINSTON CHURCHILL BLVD UNIT B2
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L6J OA3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1148 WINSTON CHURCHILL BLVD UNIT B2
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:ONTARIO
Practice Address - Zip Code:L6J OA3
Practice Address - Country:CA
Practice Address - Phone:905-338-6633
Practice Address - Fax:905-338-6659
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ9333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist