Provider Demographics
NPI:1710985338
Name:CUSHING, STANLEY R (OD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:R
Last Name:CUSHING
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 1:2480 S DOWNING ST
Mailing Address - Street 2:STE G-30
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5890
Mailing Address - Country:US
Mailing Address - Phone:303-777-3277
Mailing Address - Fax:303-698-9713
Practice Address - Street 1:2480 S DOWNING ST
Practice Address - Street 2:STE G-30
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5890
Practice Address - Country:US
Practice Address - Phone:303-777-3277
Practice Address - Fax:303-698-9713
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08009847Medicaid
CONC0167165OtherDEA
COE435-8Medicare ID - Type Unspecified
T60777Medicare UPIN