MEDICARE: DR. SHARON R ROBERTS-SUCHON O.D.

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
1	152W00000X	Optometrist	WI2028	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1447242144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON R ROBERTS-SUCHON O.D.

Provider Business Mailing Address
First Line	:	100 CARR ROAD
Second Line	:	PO BOX 600
City	:	PLYMOUTH
State	:	WI
Zip	:	53073-0600
Country	:	US
Telephone Number	:	920-893-3937
Fax Number	:	920-892-6668

Provider Business Practice Location Address
First Line	:	100 CARR ROAD
Second Line	:
City	:	PLYMOUTH
State	:	WI
Zip	:	53073-0600
Country	:	US
Telephone Number	:	920-893-3937
Fax Number	:	920-892-6668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	01/22/2013

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