Individual
SUSANNA VAYSTUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
219 W 231ST ST, BRONX, NY 10463-5301
(718) 543-8066
Mailing address
219 W 231ST ST, BRONX, NY 10463-5301
(718) 543-8066
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
006447
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02717311
—
NY
Enumeration date
06/08/2006
Last updated
05/07/2008
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