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Individual

DR. KATIE LYNNE SUTTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
6101 NEWPORT RD STE A, PORTAGE, MI 49002-9237
(269) 382-6500
(269) 382-2286
Mailing address
6101 NEWPORT RD STE A, PORTAGE, MI 49002-9237
(269) 382-6500
(269) 382-2286

Taxonomy

Speciality
Code
Description
License number
State
152WP0200X
Pediatric Optometrist
Primary
4901004789
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4901004789
LICENSE NUMBER
MI
Enumeration date
07/17/2013
Last updated
07/17/2013
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