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NPI Code Detail

MEDICARE: DR.SUSAN WESTRUP,LLC

MEDICARE: DR.SUSAN WESTRUP,LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristTUV004169-1NY
2152W00000XOptometrist27OA00423800NJ
3152W00000XOptometrist002050CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003120460
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR.SUSAN WESTRUP,LLC
Provider Business Mailing Address
First Line : 26 LITTLE FOX LN
Second Line :
City : WESTPORT
State : CT
Zip : 06880-1403
Country : US
Telephone Number : 203-644-0804
Fax Number : 203-227-6212
Provider Business Practice Location Address
First Line : 1201 BOSTON POST RD
Second Line :
City : MILFORD
State : CT
Zip : 06460-2703
Country : US
Telephone Number : 203-644-0804
Fax Number : 203-227-6212
Authorized Official
Title or Position : PRESIDENT
Name : DR. SUSAN WESTRUP
Credential : O.D.
Telephone Number : 203-644-0804
Provider Enumeration Date : 07/27/2010
Last Update Date : 07/28/2010

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