Provider Demographics
NPI:1689360661
Name:MICHELLE DITUSA OD & GEORGE T CORNWELL
Entity Type:Organization
Organization Name:MICHELLE DITUSA OD & GEORGE T CORNWELL
Other - Org Name:MICHELLE DITUSA, OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DITUSA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-880-1437
Mailing Address - Street 1:59 DUNDAS DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1370
Mailing Address - Country:US
Mailing Address - Phone:585-880-1437
Mailing Address - Fax:
Practice Address - Street 1:4235 VETERAN DR
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9442
Practice Address - Country:US
Practice Address - Phone:585-243-3940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty