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General NPI Number Information
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NPI Number | 1184773905
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Entity Type | Individual
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Provider Name | DONNA L SUITER O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 4350 24TH AVE STE 634
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3850
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Country | US
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Telephone | 810-385-0888
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Fax | 810-385-0832
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Provider Business Mailing Address
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Address Line | 4350 24TH AVE STE 634
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3853
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Country | US
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Telephone | 810-385-0888
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Fax | 810-385-0832
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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 | 4901003896
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License Number State | MI
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