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General NPI Number Information
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NPI Number | 1689360661
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Entity Type | Organization
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Legal Business Name | MICHELLE DITUSA OD & GEORGE T CORNWELL
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 4235 VETERAN DR
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City | GENESEO
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State | NY
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Zip | 14454-9442
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Country | US
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Telephone | 585-243-3940
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Fax |
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Provider Business Mailing Address
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Address Line | 59 DUNDAS DR
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City | ROCHESTER
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State | NY
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Zip | 14625-1370
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Country | US
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Telephone | 585-880-1437
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Fax |
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Authorized Official
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Title or Position | OWNER/ OPTOMETRIST
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Name | DR. MICHELLE DITUSA
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Credential | OD
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Telephone | 585-880-1437
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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 |
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License Number State |
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