Provider Demographics
NPI:1306182134
Name:PUSATERI, GREGG C (OD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:C
Last Name:PUSATERI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5614 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1940
Mailing Address - Country:US
Mailing Address - Phone:719-471-3200
Mailing Address - Fax:
Practice Address - Street 1:5614 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1940
Practice Address - Country:US
Practice Address - Phone:719-471-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007939152WL0500X
COOPT.0003639152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation