Provider Demographics
NPI:1730261587
Name:J JAMES SUYDAM OD PC
Entity type:Organization
Organization Name:J JAMES SUYDAM OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SUYDAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:610-323-0133
Mailing Address - Street 1:2087 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3211
Mailing Address - Country:US
Mailing Address - Phone:610-323-0133
Mailing Address - Fax:510-323-3224
Practice Address - Street 1:2087 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3211
Practice Address - Country:US
Practice Address - Phone:610-323-0133
Practice Address - Fax:610-323-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA507783Medicare PIN
PA0199970001Medicare NSC