Provider Demographics
NPI:1124021894
Name:BELL, SUSAN A (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:BELL
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 1:1964 N OLDEN AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2110
Mailing Address - Country:US
Mailing Address - Phone:609-883-4407
Mailing Address - Fax:609-883-4085
Practice Address - Street 1:1964 N OLDEN AVENUE EXT
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-2110
Practice Address - Country:US
Practice Address - Phone:609-883-4407
Practice Address - Fax:609-883-4085
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ271A00364200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1693603Medicaid
NJT92047Medicare UPIN
NJ577876DBPMedicare ID - Type Unspecified