Provider Demographics
NPI:1194033126
Name:CHRISTOPHER C FUSCO OD INC
Entity Type:Organization
Organization Name:CHRISTOPHER C FUSCO OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-424-4177
Mailing Address - Street 1:812 EDEN WAY N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0602
Mailing Address - Country:US
Mailing Address - Phone:757-424-4177
Mailing Address - Fax:757-424-0496
Practice Address - Street 1:812 EDEN WAY N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0602
Practice Address - Country:US
Practice Address - Phone:757-424-4177
Practice Address - Fax:757-424-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000205152W00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA102585Medicare PIN
VAT83551Medicare UPIN