Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046011239 | IL |
NPI | 1003395633 |
---|---|
Provider Name | Dr. Susan Sarrafi |
First Address | Vienna, VA 22182-3970 |
Second Address | Highland Park, IL 60035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 27/08/2018 |