Provider Demographics
NPI:1902987456
Name:COTTER, SUSAN L (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:COTTER
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 1:8601 MUKILTEO SPEEDWAY
Mailing Address - Street 2:SUITE #501
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5478
Mailing Address - Country:US
Mailing Address - Phone:425-513-9186
Mailing Address - Fax:
Practice Address - Street 1:8601 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE #501
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5478
Practice Address - Country:US
Practice Address - Phone:425-513-9186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1476TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021293Medicaid
WA2021285Medicaid
WA0601380001Medicare NSC
WAU24078Medicare UPIN
WA2021293Medicaid