Healthcare Provider Details

I. General information

NPI: 1437487659
Provider Name (Legal Business Name): SUJEY KUAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2009
Last Update Date: 05/25/2020
Certification Date: 05/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32660 US HIGHWAY 19 N
PALM HARBOR FL
34684-3113
US

IV. Provider business mailing address

32660 US HIGHWAY 19 N
PALM HARBOR FL
34684-3113
US

V. Phone/Fax

Practice location:
  • Phone: 727-430-9359
  • Fax: 727-223-5808
Mailing address:
  • Phone: 727-430-9359
  • Fax: 727-223-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 4472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: