Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | ||
Y | 156FX1800X | Optician |
NPI | 1154757169 |
---|---|
Provider Name | Mr. Joseph D Cussatt |
First Address | West Hazleton, PA 18202-1551 |
Second Address | West Hazleton, PA 18202-1551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2013 |
Last Update Date | 23/09/2013 |