Provider Demographics
NPI:1841224599
Name:FUSCO, ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:FUSCO
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 1:6 MARCH AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-4012
Mailing Address - Country:US
Mailing Address - Phone:603-898-8252
Mailing Address - Fax:603-898-1534
Practice Address - Street 1:99 ROCKINGHAM RD
Practice Address - Street 2:SUITE W-161
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2125
Practice Address - Country:US
Practice Address - Phone:603-898-8252
Practice Address - Fax:603-898-1534
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHU84064Medicare UPIN