Provider Demographics
NPI:1730208950
Name:POINDEXTER, SUSANNE A (LDO, CPOT)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:A
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:LDO, CPOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 SIRSTAD ST
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7230
Mailing Address - Country:US
Mailing Address - Phone:907-966-8415
Mailing Address - Fax:907-966-8665
Practice Address - Street 1:222 TONGASS DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9416
Practice Address - Country:US
Practice Address - Phone:907-966-8415
Practice Address - Fax:907-966-8665
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK275156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician