=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942330220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD EUSANIO, D.P.M.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 08/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1645 N TOWN EAST BLVD #502
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-4158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-270-3338
-----------------------------------------------------
Fax | 972-270-7882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1645 N TOWN EAST BLVD #502
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-4158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-270-3338
-----------------------------------------------------
Fax | 972-270-7882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD EUSANIO
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 972-270-3338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 0440
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------