Healthcare Provider Details

I. General information

NPI: 1134036189
Provider Name (Legal Business Name): ALLISON SUSSMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

71 E 11TH AVE
COLUMBUS OH
43201-2126
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007532
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOPT.007532
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: