Provider Demographics
NPI:1992944938
Name:STALLINGS, SUSAN B (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:STALLINGS
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 1:859 NERO CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1219
Mailing Address - Country:US
Mailing Address - Phone:317-816-0151
Mailing Address - Fax:
Practice Address - Street 1:859 NERO CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1219
Practice Address - Country:US
Practice Address - Phone:317-816-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-15
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002446B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
194820OtherMEDICARE PART B PROVIDER NUMBER
U42462Medicare UPIN
893020Medicare PIN