MEDICARE: DR. DEVYN LEE USUKA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000104	PA

General Provider Information

NPI Number	:	1003809401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVYN LEE USUKA O.D.

Provider Business Mailing Address
First Line	:	123 E MARKET ST
Second Line	:
City	:	ORWIGSBURG
State	:	PA
Zip	:	17961-1953
Country	:	US
Telephone Number	:	570-366-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 E MARKET ST
Second Line	:
City	:	ORWIGSBURG
State	:	PA
Zip	:	17961-1953
Country	:	US
Telephone Number	:	570-366-2080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	02/10/2008

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