Provider Demographics
NPI:1306967732
Name:DR. SUSAN BETTS
Entity type:Organization
Organization Name:DR. SUSAN BETTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:302-629-6691
Mailing Address - Street 1:23094 ATLANTA RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-6911
Mailing Address - Country:US
Mailing Address - Phone:302-629-6691
Mailing Address - Fax:
Practice Address - Street 1:23094 ATLANTA RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-6911
Practice Address - Country:US
Practice Address - Phone:302-629-6691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI30001158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE32341OtherCOVENTRY
DE1419229005OtherCIGNA
DE560251OtherAETNA
DE1578566923OtherSOLO PROVIDER NPI
DED000403OtherCHAMPUS TRICARE
DE225125OtherMAMSI
DE410005314OtherRAILROAD MEDICARE
DE32341OtherCOVENTRY
DE410005314OtherRAILROAD MEDICARE
DE118106Medicare ID - Type Unspecified