Provider Demographics
NPI:1932164860
Name:PLACE, SUZETTE M (OD)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:M
Last Name:PLACE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7761 SHAFFER PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3728
Mailing Address - Country:US
Mailing Address - Phone:303-979-4505
Mailing Address - Fax:
Practice Address - Street 1:7761 SHAFFER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-3728
Practice Address - Country:US
Practice Address - Phone:303-979-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94667Medicare UPIN