MEDICARE: SUSAN H PAYNE 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	OPC3517	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20976	OTHER	FL	BCBS FLORIDA
2	2508546	OTHER	FL	AENTA
3	7286206	OTHER	FL	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	6599633	OTHER	NY	GHI

General Provider Information

NPI Number	:	1497752356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN H PAYNE O.D.

Provider Business Mailing Address
First Line	:	403 VONDERBURG DR
Second Line	:	STE 101
City	:	BRANDON
State	:	FL
Zip	:	33511-5982
Country	:	US
Telephone Number	:	813-681-1122
Fax Number	:	813-684-4924

Provider Business Practice Location Address
First Line	:	4051 UPPER CREEK DR
Second Line	:	STE 107
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6825
Country	:	US
Telephone Number	:	813-634-8877
Fax Number	:	813-634-2266

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	07/24/2013

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Directions to “ SUSAN H PAYNE O.D.” Practice Location

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