Individual
LISA LA SUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1437 S MAIN ST, WEST BEND, WI 53095-4931
(262) 334-1925
Mailing address
1437 S MAIN ST, WEST BEND, WI 53095-4931
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3336-35
WI
152W00000X
Optometrist
8496T
TX
Other
Enumeration date
06/11/2014
Last updated
06/11/2014
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