Provider Demographics
NPI:1366180945
Name:FALKOWSKI, SUZANNE (OD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:FALKOWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:PHALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156332 JOHNSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-8014
Mailing Address - Country:US
Mailing Address - Phone:715-551-9774
Mailing Address - Fax:
Practice Address - Street 1:7913 ALLISON WAY STE 102
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-4450
Practice Address - Country:US
Practice Address - Phone:303-578-2982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist