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General NPI Number Information
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NPI Number | 1811101389
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Entity Type | Organization
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Legal Business Name | SUSAN BALDWIN, OD & ASSOCIATES
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5900 SUNRISE MALL
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-6902
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Country | US
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Telephone | 916-061-0395
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Fax | 916-961-0396
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Provider Business Mailing Address
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Address Line | 5900 SUNRISE MALL
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-6902
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Country | US
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Telephone | 916-061-0395
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Fax | 916-961-0396
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Authorized Official
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Title or Position | OD OWNER
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Name | SUSAN BALDWIN
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Credential | OD
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Telephone | 916-961-0395
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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 | 11460T
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License Number State | CA
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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 | 12369T
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License Number State | CA
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