Healthcare Provider Details

I. General information

NPI: 1780853317
Provider Name (Legal Business Name): SUE E. VAN DOOTINGH OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 JEFFERSON ST
PORT CLINTON OH
43452-2416
US

IV. Provider business mailing address

820 JEFFERSON ST
PORT CLINTON OH
43452-2416
US

V. Phone/Fax

Practice location:
  • Phone: 419-732-2828
  • Fax: 419-734-5914
Mailing address:
  • Phone: 419-732-2828
  • Fax: 419-734-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. SUE E VAN DOOTINGH
Title or Position: OPTOMETRIST
Credential: OD
Phone: 419-732-2828