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Contact Information

SUSAN M PENNER, OD
134 E BLACKHAWK DR
BYRON, IL61010
 Phone: 815-234-2020
 Fax: 815-234-7070
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for SUSAN M PENNER · (Female)

NPI # 1891842464
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 01/04/2007
Last updated 06/18/2018 - About 8 years ago
Sole proprietor 1 Yes
Identifiers
  • IL License # 046-008009
  • IL Other 4515286 BLUE CROSS BLUE SHIELD
  • IL Other 7184011 BLUE CROSS BLUE SHIELD
  • IL Other 046-008009 OPTOMETRY LICENSE
  • IL Other L08182 PIN
  • IL Other 410033446 RAILROAD MEDICARE
  • IL Other CL7273 RAILROAD MEDICARE GROUP
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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