MEDICARE: ELIZABETH SUH, O.D. LLC

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	802	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558863266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH SUH, O.D. LLC

Provider Business Mailing Address
First Line	:	949 HUNTINGTON COVE PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-2301
Country	:	US
Telephone Number	:	949-433-2512
Fax Number	:	702-826-4889

Provider Business Practice Location Address
First Line	:	4517 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3760
Country	:	US
Telephone Number	:	702-489-5464
Fax Number	:	702-826-4889

Authorized Official
Title or Position	:	O.D.
Name	:	DR. ELIZABETH SUH
Credential	:	O.D.
Telephone Number	:	949-433-2512

Provider Enumeration Date	:	03/08/2018
Last Update Date	:	03/08/2018

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