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General NPI Number Information
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NPI Number | 1740495225
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Entity Type | Organization
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Legal Business Name | DR GARY CUSHING OD INC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 09/10/2010
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Provider Practice Location Address
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Address Line | 2911 E HATCH RD
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City | MODESTO
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State | CA
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Zip | 95351-4921
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Country | US
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Telephone | 209-537-2359
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Fax | 209-537-4802
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Provider Business Mailing Address
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Address Line | 2911 EAST HATCH RD
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City | MODESTO
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State | CA
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Zip | 95351-4921
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Country | US
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Telephone | 209-537-2359
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Fax | 209-537-4802
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | DR. GARY MARK CUSHING
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Credential | OD
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Telephone | 209-537-2359
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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 | 4418T
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License Number State | CA
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