Healthcare Provider Details

I. General information

NPI: 1285072652
Provider Name (Legal Business Name): SUZANNE WESTBROOK VAN LANDINGHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS SUZANNE HOPE WESTBROOK

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 UNIVERSITY AVE
MADISON WI
53705-3644
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-7171
  • Fax: 608-265-8060
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number66976
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number66976
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: