Healthcare Provider Details

I. General information

NPI: 1467634105
Provider Name (Legal Business Name): SUZANNE S O'CONNOR AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 N MERIDIAN ST STE 210
INDIANAPOLIS IN
46260-5315
US

IV. Provider business mailing address

8801 N MERIDIAN ST STE 210
INDIANAPOLIS IN
46260-5315
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-8127
  • Fax:
Mailing address:
  • Phone: 317-844-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number23001452A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: