Provider Demographics
NPI:1427042209
Name:CUSNER, ALICE A (OD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:A
Last Name:CUSNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3001
Mailing Address - Country:US
Mailing Address - Phone:781-821-1225
Mailing Address - Fax:781-821-8160
Practice Address - Street 1:537 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3001
Practice Address - Country:US
Practice Address - Phone:781-821-1225
Practice Address - Fax:781-821-8160
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0348597Medicaid
MA211058Medicare PIN
T59351Medicare UPIN