MEDICARE: SUZANNE J BIRNBAUM O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC 4207	FL

General Provider Information

NPI Number	:	1417140054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE J BIRNBAUM O.D.

Provider Business Mailing Address
First Line	:	155 CRANES ROOST BLVD
Second Line	:	SUITE 1060
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3468
Country	:	US
Telephone Number	:	407-478-4800
Fax Number	:	407-478-4805

Provider Business Practice Location Address
First Line	:	155 CRANES ROOST BLVD
Second Line	:	SUITE 1060
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3468
Country	:	US
Telephone Number	:	407-478-4800
Fax Number	:	407-478-4805

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	05/02/2014

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