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General NPI Number Information
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NPI Number | 1407917040
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Entity Type | Organization
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Legal Business Name | JOANNA KUSHON O.D. P.C.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 3590 HOLLAND RD SUITE 104
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4053
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Country | US
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Telephone | 757-340-9680
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Fax | 757-463-5496
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Provider Business Mailing Address
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Address Line | 3590 HOLLAND RD SUITE 104
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4053
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Country | US
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Telephone | 757-340-9680
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Fax | 757-463-5496
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOANNA CAROLE KUSHON
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Credential | O.D.
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Telephone | 757-340-9680
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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 | 0618001249
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License Number State | VA
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