MEDICARE: CUSSATT EYEWEAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156F00000X	Technician/Technologist
2	156FX1800X	Optician	21950	PA

General Provider Information

NPI Number	:	1164895611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUSSATT EYEWEAR

Provider Business Mailing Address
First Line	:	601 N BROAD ST
Second Line	:
City	:	WEST HAZLETON
State	:	PA
Zip	:	18202-1551
Country	:	US
Telephone Number	:	570-455-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 N BROAD ST
Second Line	:
City	:	WEST HAZLETON
State	:	PA
Zip	:	18202-1551
Country	:	US
Telephone Number	:	570-455-1100
Fax Number	:	570-455-1101

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH CUSSATT
Credential	:
Telephone Number	:	570-455-1100

Provider Enumeration Date	:	11/05/2015
Last Update Date	:	11/05/2015

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Directions to “CUSSATT EYEWEAR ” Practice Location

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