Active NPI
Suzanne McLean Hazen, OD
- Optometrist
- Telluride, CO
National Provider Identifier
1770549370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2372
- Practice address
- 220 E. Colorado Ave
Suite 210
Telluride, CO 81435 - Phone
- (970) 708-4890
- Fax
- (970) 728-8987
- NPI assigned
- Apr 22, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 12300T | CA | |
| Optometrist | 152W00000X | 2372 | CO | Primary |
Addresses
Primary practice location
220 E. Colorado Ave
Suite 210
Telluride, CO 81435
Mailing address
PO Box 3110
Telluride, CO 81435-3110
Phone (970) 708-4890
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27602885 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12300T | CA | MD | Optometrist |
| 2372 | CO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398211200000",
"number": "1770549370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3110",
"city": "TELLURIDE",
"state": "CO",
"postal_code": "814353110",
"telephone_number": "970-708-4890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 E. COLORADO AVE",
"address_2": "SUITE 210",
"city": "TELLURIDE",
"state": "CO",
"postal_code": "81435",
"telephone_number": "970-708-4890",
"fax_number": "970-728-8987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAZEN",
"first_name": "SUZANNE",
"middle_name": "MCLEAN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-22",
"last_updated": "2014-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12300T",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CO",
"license": "2372",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "27602885",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Telluride, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.