Individual
ROSE SUSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD OPTOMETRIST
Contact information
Practice address
2510 HOWARD GROVE RD, DAVIDSONVILLE, MD 21035
(410) 533-7763
(410) 956-2594
Mailing address
2510 HOWARD GROVE RD, DAVIDSONVILLE, MD 21035
(410) 533-7763
(410) 956-2594
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0601001725
VA
152W00000X
Optometrist
OP661
DC
152W00000X
Optometrist
Primary
TA1082
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018590600
—
DC
05
—
081778300
—
MD
Enumeration date
01/24/2007
Last updated
03/14/2010
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