Healthcare Provider Details

I. General information

NPI: 1124200373
Provider Name (Legal Business Name): SUSAN HOUCHIN OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10751 RANDOLPH ST
CROWN POINT IN
46307-7615
US

IV. Provider business mailing address

10751 RANDOLPH ST
CROWN POINT IN
46307-7615
US

V. Phone/Fax

Practice location:
  • Phone: 219-226-9477
  • Fax: 219-226-9481
Mailing address:
  • Phone: 219-226-9477
  • Fax: 219-226-9481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002870B
License Number StateIN

VIII. Authorized Official

Name: DR. SUSAN E HOUCHIN
Title or Position: OWNER
Credential: O.D.
Phone: 219-226-9477