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General NPI Number Information
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NPI Number | 1295834299
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Entity Type | Individual
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Provider Name | PENELOPE SHOLES SUTER O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 5300 CALIFORNIA AVE STE 210
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City | BAKERSFIELD
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State | CA
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Zip | 93309-1642
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Country | US
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Telephone | 661-869-2010
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Fax | 661-869-2708
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Provider Business Mailing Address
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Address Line | 5300 CALIFORNIA AVE STE 210
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City | BAKERSFIELD
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State | CA
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Zip | 93309-1642
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Country | US
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Telephone | 661-869-2010
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Fax | 661-869-2708
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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 | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 08128T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 08128T
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License Number State | CA
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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 | 08128T
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License Number State | CA
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