Healthcare Provider Details

I. General information

NPI: 1104864313
Provider Name (Legal Business Name): MICHAEL L SUSSEX OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MARSHALL ST
COLDWATER MI
49036
US

IV. Provider business mailing address

350 MARSHALL ST
COLDWATER MI
49036
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-6303
  • Fax: 517-279-6010
Mailing address:
  • Phone: 517-278-6303
  • Fax: 517-279-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L SUSSEX
Title or Position: PRESIDENT
Credential: OD
Phone: 517-278-6303