Provider Demographics
NPI:1881825339
Name:SAFRATOWICH, SUSAN M (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:SAFRATOWICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2900 S COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6070
Mailing Address - Country:US
Mailing Address - Phone:701-746-6745
Mailing Address - Fax:701-746-6961
Practice Address - Street 1:2900 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6070
Practice Address - Country:US
Practice Address - Phone:701-746-6745
Practice Address - Fax:701-746-6745
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2015-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND676152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDND-60679Medicaid
NDN714688Medicare PIN