Provider Demographics
NPI:1558327742
Name:DUSSE, JON L (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:L
Last Name:DUSSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3260
Mailing Address - Country:US
Mailing Address - Phone:716-631-8888
Mailing Address - Fax:716-631-3803
Practice Address - Street 1:811 MAPLE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3260
Practice Address - Country:US
Practice Address - Phone:716-631-8888
Practice Address - Fax:716-631-3803
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182572-2207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01566650Medicaid
NY161000580OtherNORTH AMERICAN PREFERRED
NY0807280OtherIHA
NY161000580OtherEMPIRE
NY0021748OtherGHI
NY182572-8BOtherWORKERS COMPENSATION
NY00010049101OtherUNIVERA
NY180023659OtherRR MEDICARE
NY000523681001OtherHEALTH NOW
NYG11352Medicare UPIN
NY0021748OtherGHI