Provider Demographics
NPI:1982615449
Name:ANDERSON, SUZANNE EMERITA (OD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:EMERITA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:NADINE EMERITA
Other - Last Name:GENTLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8010 DOVE FLIGHT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250
Mailing Address - Country:US
Mailing Address - Phone:210-682-3773
Mailing Address - Fax:210-682-3773
Practice Address - Street 1:6301 NW LOOP 410
Practice Address - Street 2:SEARS BUILDING
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3824
Practice Address - Country:US
Practice Address - Phone:210-682-3773
Practice Address - Fax:210-682-3773
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4650TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist