Provider Demographics
NPI:1609675396
Name:TRADER, SUSAN BAILEY (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BAILEY
Last Name:TRADER
Suffix:
Gender:
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 ENTERPRISE DR STE I
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3260
Mailing Address - Country:US
Mailing Address - Phone:336-757-1120
Mailing Address - Fax:336-757-1202
Practice Address - Street 1:4310 ENTERPRISE DR STE I
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3260
Practice Address - Country:US
Practice Address - Phone:336-757-1120
Practice Address - Fax:336-757-1202
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1638156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist