Provider Demographics
NPI:1568527778
Name:HUSSON, DEBORAH LUCIANO (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LUCIANO
Last Name:HUSSON
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 1:6OO CYPRESS STREET
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-3919
Mailing Address - Country:US
Mailing Address - Phone:215-361-8578
Mailing Address - Fax:
Practice Address - Street 1:858 E WELSH RD
Practice Address - Street 2:SUITE 12
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002-2942
Practice Address - Country:US
Practice Address - Phone:215-542-0460
Practice Address - Fax:215-542-9058
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE 006778T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHU1586714Medicare ID - Type Unspecified
PAU01479Medicare UPIN