Provider Demographics
NPI:1366493512
Name:PRZETAK-CASE, SUSAN (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:PRZETAK-CASE
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 1:17 KRISTEN CT
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1053
Mailing Address - Country:US
Mailing Address - Phone:973-257-0649
Mailing Address - Fax:973-257-0902
Practice Address - Street 1:440 MAIN RD
Practice Address - Street 2:
Practice Address - City:TOWACO
Practice Address - State:NJ
Practice Address - Zip Code:07082-1288
Practice Address - Country:US
Practice Address - Phone:973-316-2626
Practice Address - Fax:973-316-3066
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00485600152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ627175Medicare ID - Type Unspecified
NJP01009088Medicare PIN
NJU02742Medicare UPIN