Provider Demographics
NPI:1568490654
Name:CUSIC, ROSS (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:CUSIC
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 1:12011 124TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8204
Mailing Address - Country:US
Mailing Address - Phone:425-823-2020
Mailing Address - Fax:425-823-1748
Practice Address - Street 1:12011 124TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-8204
Practice Address - Country:US
Practice Address - Phone:425-823-2020
Practice Address - Fax:425-823-1748
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3826T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist