Provider Demographics
NPI:1407859879
Name:COUZINS, CHRISTOPHER SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:COUZINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23 NORTH MAIN STREET
Mailing Address - Street 2:P.O. BOX 578
Mailing Address - City:HOLLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14080
Mailing Address - Country:US
Mailing Address - Phone:716-537-2222
Mailing Address - Fax:716-537-2222
Practice Address - Street 1:23 NORTH MAIN STREET
Practice Address - Street 2:BOX 578
Practice Address - City:HOLLAND
Practice Address - State:NY
Practice Address - Zip Code:14080
Practice Address - Country:US
Practice Address - Phone:716-537-2222
Practice Address - Fax:716-537-2222
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005394-1152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300010512Medicare PIN
NYU28154Medicare ID - Type Unspecified