Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 000866 | CT |
NPI | 1013026988 |
---|---|
Provider Name | Dr. Robert C. Cushing |
First Address | Manchester, CT 06040-5986 |
Second Address | Manchester, CT 06040-5986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 21/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T65008 | (02) |