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General NPI Number Information
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NPI Number | 1003120460
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Entity Type | Organization
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Legal Business Name | DR.SUSAN WESTRUP,LLC
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 1201 BOSTON POST RD
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City | MILFORD
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State | CT
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Zip | 06460-2703
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Country | US
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Telephone | 203-644-0804
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Fax | 203-227-6212
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Provider Business Mailing Address
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Address Line | 26 LITTLE FOX LN
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City | WESTPORT
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State | CT
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Zip | 06880-1403
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Country | US
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Telephone | 203-644-0804
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Fax | 203-227-6212
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN WESTRUP
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Credential | O.D.
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Telephone | 203-644-0804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV004169-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00423800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002050
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License Number State | CT
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