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General NPI Number Information
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NPI Number | 1033189626
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Entity Type | Individual
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Provider Name | LAWRENCE MICHAEL CUSMA O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 9 GLEASON RD
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City | SCHENECTADY
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State | NY
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Zip | 12302-5307
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Country | US
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Telephone | 518-399-6368
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Fax | 518-399-6372
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Provider Business Mailing Address
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Address Line | 166 MIDDLELINE RD
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City | BALLSTON SPA
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State | NY
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Zip | 12020-3406
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Country | US
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Telephone | 518-885-5425
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Fax | 518-399-6372
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV003340-1
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License Number State | NY
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