Provider Demographics
NPI:1952595589
Name:SUITS, STEPHANIE (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SUITS
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 1:11729 N KEY LIME PL
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9713
Mailing Address - Country:US
Mailing Address - Phone:618-841-1199
Mailing Address - Fax:
Practice Address - Street 1:7635 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4202
Practice Address - Country:US
Practice Address - Phone:520-297-2704
Practice Address - Fax:520-297-2843
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009986152W00000X
AZ1652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist