Provider Demographics
NPI:1184726176
Name:KAPLAN, SUSAN L (OD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:KAPLAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19420 N 59TH AVE
Mailing Address - Street 2:SUITE E-525
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6894
Mailing Address - Country:US
Mailing Address - Phone:602-843-2900
Mailing Address - Fax:602-843-0233
Practice Address - Street 1:19420 N 59TH AVE
Practice Address - Street 2:SUITE E-525
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6894
Practice Address - Country:US
Practice Address - Phone:602-843-2900
Practice Address - Fax:602-843-0233
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ683152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0902300OtherBLUE CROSS BLUE SHIELD
AZ4961130001Medicare NSC
AZAZ0902300OtherBLUE CROSS BLUE SHIELD
AZ4961130002Medicare NSC
AZT41802Medicare UPIN