Provider Demographics
NPI:1629252143
Name:ALICE A. CUSNER, O.D.,P.C.
Entity Type:Organization
Organization Name:ALICE A. CUSNER, O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUSNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-821-1225
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:866-367-9090
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:866-367-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3025332B00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA03485997Medicaid
MA03485997Medicaid
0468250001Medicare NSC
MA211058Medicare PIN