Healthcare Provider Details

I. General information

NPI: 1164485405
Provider Name (Legal Business Name): SUSAN B STEWART O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN BEALL LUKS OD

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S POTOMAC ST SUITE 155
AURORA CO
80012
US

IV. Provider business mailing address

1550 S POTOMAC ST SUITE 155
AURORA CO
80012
US

V. Phone/Fax

Practice location:
  • Phone: 303-369-1020
  • Fax:
Mailing address:
  • Phone: 303-369-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS798TA211
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14677TPG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: