Healthcare Provider Details

I. General information

NPI: 1083962781
Provider Name (Legal Business Name): SUZANNE M HAZEN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E COLORADO AVE 210
TELLURIDE CO
81435
US

IV. Provider business mailing address

PO BOX 3110
TELLURIDE CO
81435-3110
US

V. Phone/Fax

Practice location:
  • Phone: 970-708-4890
  • Fax: 970-728-8987
Mailing address:
  • Phone: 970-708-4890
  • Fax: 970-728-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SUZANNE MCLEAN HAZEN
Title or Position: PRESIDENT
Credential: OD
Phone: 970-708-4890