Provider Demographics
NPI:1033189626
Name:CUSMA, LAWRENCE MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MICHAEL
Last Name:CUSMA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:166 MIDDLELINE RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3406
Mailing Address - Country:US
Mailing Address - Phone:518-885-5425
Mailing Address - Fax:518-399-6372
Practice Address - Street 1:9 GLEASON RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12302-5307
Practice Address - Country:US
Practice Address - Phone:518-399-6368
Practice Address - Fax:518-399-6372
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003340-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
37077BMedicare PIN
NY0260860001Medicare NSC
NYT26479Medicare UPIN