Individual
SUSAN GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1500 COMMERCE RD, STAUNTON, VA 24401-9032
(540) 213-7720
(540) 213-9441
Mailing address
17 N MEDICAL PARK DR, FISHERSVILLE, VA 22939-2344
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618002780
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053975763
—
VA
Enumeration date
04/28/2019
Last updated
07/07/2020
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