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General NPI Number Information
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NPI Number | 1396162202
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Entity Type | Organization
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Legal Business Name | LAWRENCE MICHAEL CUSMA, OD
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 9 GLEASON RD
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City | SCOTIA
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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 | 9 GLEASON RD
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City | SCOTIA
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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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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. LAWRENCE MICHAEL CUSMA
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Credential | O.D.
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Telephone | 518-399-6368
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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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