Susan Simpson Sullenberger, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 0003530 Issued in FL

Practice address

1699 N Woodland Blvd
Deland, FL 32720-1803

Phone

(386) 734-2240

Fax

(386) 734-2240

NPI assigned

May 14, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2000

Medicare assignment

May accept Medicare assignment

Group practices

Charles D Register OD, PAGroup PAC ID 8820206162, 3 clinicians

Coastal Eye Associates Inc.Group PAC ID 8921095092, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Beach Vision Holdings, PA

  dba Beach Vision Center

  • Optometrist
  • New Smyrna Beach, FL
  • NPI 1346516747
  Medicare reassignment Care Compare group NPD Authorized official
• Coastal Eye Associates Inc

  • Optometrist
  • Deland, FL
  • NPI 1356511281
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700092350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1699 N WOODLAND BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327201803",
            "telephone_number": "386-734-2240",
            "fax_number": "386-734-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1699 N WOODLAND BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327201803",
            "telephone_number": "386-734-2240",
            "fax_number": "386-734-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLENBERGER",
        "first_name": "SUSAN",
        "middle_name": "SIMPSON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 0003530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Stowers
• Leighann Straughen, L.M.H.C.
• Eric Strawser, HAS
• Jesna Susan Mathew Sublett, MBBS
• David Sukhai
• Taylor Anne Sullivan, M.S., ATC
• Lisa Dianne Summers, LMFT
• Sunny Ridge Retirement and Alf
• Sunrise Pediatric Care Center LLC
• Sunshine Therapy & Health Center, LLC

• Optometrist in Deland, FL
• Providers in Deland, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.