Provider Demographics
NPI:1053503912
Name:ANDREW S JUSKO MD PC
Entity Type:Organization
Organization Name:ANDREW S JUSKO MD PC
Other - Org Name:EYESIGHT AND SURGERY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUSKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-736-1833
Mailing Address - Street 1:299 CAREW ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2360
Mailing Address - Country:US
Mailing Address - Phone:413-736-1833
Mailing Address - Fax:413-781-1899
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2360
Practice Address - Country:US
Practice Address - Phone:413-736-1833
Practice Address - Fax:413-781-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223046207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9790667Medicaid
MA0002295Medicare PIN
MA9790667Medicaid