Provider Demographics
NPI:1619498078
Name:BURMAYAN, SUZAN (OD)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:BURMAYAN
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 1:120 W BONITA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-5000
Mailing Address - Country:US
Mailing Address - Phone:909-599-1100
Mailing Address - Fax:
Practice Address - Street 1:120 W BONITA AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-5000
Practice Address - Country:US
Practice Address - Phone:909-599-1100
Practice Address - Fax:909-394-1743
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty