Healthcare Provider Details

I. General information

NPI: 1730208950
Provider Name (Legal Business Name): SUSANNE A POINDEXTER LDO, CPOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

706 SIRSTAD ST
SITKA AK
99835-7230
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-8415
  • Fax: 907-966-8665
Mailing address:
  • Phone: 907-966-8415
  • Fax: 907-966-8665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number275
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: