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Individual

DR. MARCIA KOSTKA-SUVELZA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
604 I ST, LA PORTE, IN 46350-5530
(219) 326-8855
(219) 326-8835
Mailing address
604 I ST, LA PORTE, IN 46350-5530
(219) 326-8855
(219) 326-8835

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002824
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200108470A
IN
Enumeration date
12/14/2005
Last updated
08/29/2014
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