Organization
SUSON OPTICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN D SUSON M.D. (PRESIDENT)
(414) 475-5550
Entity
Organization
Contact information
Practice address
2300 N MAYFAIR RD, SUITE 1101, WAUWATOSA, WI 53226-1505
(414) 443-5289
(414) 475-5550
Mailing address
2300 N MAYFAIR RD, SUITE 1101, WAUWATOSA, WI 53226-1505
(414) 443-5289
(414) 475-5550
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30936300
—
WI
05
—
32169600
—
WI
05
—
32237800
—
WI
05
—
38530200
—
WI
Enumeration date
03/16/2007
Last updated
12/21/2012
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