Provider Demographics
NPI:1902050735
Name:DR. SUZANNE PROLEIKA, O.D.
Entity Type:Organization
Organization Name:DR. SUZANNE PROLEIKA, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROLEIKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-883-9696
Mailing Address - Street 1:1817 MURRAY STREET
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-883-9696
Mailing Address - Fax:570-883-7265
Practice Address - Street 1:1201 OAK ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3798
Practice Address - Country:US
Practice Address - Phone:570-883-9696
Practice Address - Fax:570-883-7265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty