Individual
MRS. SUZANNE R MAYSTEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1311 E BRIDGE STREET, PORTLAND, MI 48875
(517) 647-7515
(517) 647-5445
Mailing address
1311 E BRIDGE STREET, PORTLAND, MI 48875
(517) 647-7515
(517) 647-5445
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901SM002704
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200000002364
PHP
—
01
—
SM002704
BLUE CROSS
—
Enumeration date
01/09/2006
Last updated
04/07/2011
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