Individual
DR. SUE ELLEN VAN DOOTINGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
820 JEFFERSON ST, PORT CLINTON, OH 43452-2416
(419) 732-2828
Mailing address
820 JEFFERSON ST, PORT CLINTON, OH 43452-2416
(419) 732-2828
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3643
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0629387
—
OH
Enumeration date
11/27/2006
Last updated
07/30/2009
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