Susan Diane Devine, T.V.I.
Individual provider Active NPI Specialist · Bowling Green, KY
NPI 1467653162 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1467653162
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- VISION CERTIFICATION (TN)
- Practice address
- 812 Wrenwood Dr
Bowling Green, KY 42103-1582 - Phone
- (270) 779-7564
- Fax
- (270) 842-6011
- NPI assigned
- May 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| VISION CERTIFICATION | TN | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | VISION CERTIFICATION | TN | Yes |
Addresses
Primary practice location
812 Wrenwood Dr
Bowling Green, KY 42103-1582
Mailing address
812 Wrenwood Dr
Bowling Green, KY 42103-1582
Phone (270) 779-7564
Other providers in Bowling Green, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.