Healthcare Provider Details

I. General information

NPI: 1417994914
Provider Name (Legal Business Name): SUSAN HILBORN MCCUTCHEON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN GAY HILBORN OD

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N MONROE ST
MONROE MI
48162-3190
US

IV. Provider business mailing address

1180 N MONROE ST
MONROE MI
48162-3190
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-5300
  • Fax:
Mailing address:
  • Phone: 734-243-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003301
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: