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General NPI Number Information
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NPI Number | 1073504551
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Entity Type | Individual
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Provider Name | SUSANA CON OD
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 850 S ATLANTIC BLVD STE 301
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City | MONTEREY PARK
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State | CA
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Zip | 91754-6710
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Country | US
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Telephone | 323-726-6888
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Fax | 213-628-1239
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Provider Business Mailing Address
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Address Line | 850 S ATLANTIC BLVD STE 301
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City | MONTEREY PARK
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State | CA
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Zip | 91754-6710
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Country | US
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Telephone | 323-726-6888
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Fax | 213-628-1239
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT9656TPA
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License Number State | CA
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