Healthcare Provider Details

I. General information

NPI: 1437103744
Provider Name (Legal Business Name): SUZANNE MARIE DAY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 GULF BREEZE PKWY SUITE 210
GULF BREEZE FL
32561-7809
US

IV. Provider business mailing address

1040 GULF BREEZE PKWY SUITE 210
GULF BREEZE FL
32561-7809
US

V. Phone/Fax

Practice location:
  • Phone: 850-932-4184
  • Fax: 850-934-1179
Mailing address:
  • Phone: 850-932-4184
  • Fax: 850-934-1179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 4091
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC 4091
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberOPC 4091
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: