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General NPI Number Information
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NPI Number | 1699744573
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Entity Type | Organization
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Legal Business Name | SUSON EYE SPECIALISTS, MD SC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 11/12/2012
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Provider Practice Location Address
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Address Line | 2300 N MAYFAIR RD SUITE 1101
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City | WAUWATOSA
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State | WI
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Zip | 53226-1505
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Country | US
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Telephone | 414-475-5550
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Fax | 414-475-0249
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Provider Business Mailing Address
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Address Line | 2300 N MAYFAIR RD SUITE 1101
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City | WAUWATOSA
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State | WI
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Zip | 53226-1505
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Country | US
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Telephone | 414-475-5550
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Fax | 414-475-0249
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Authorized Official
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Title or Position | MANAGING DOCTOR
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Name | DR. JOHN DAVID SUSON
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Credential | M.D.
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Telephone | 414-475-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 33392
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 34950
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License Number State | WI
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