Provider Demographics
NPI:1871642207
Name:KUSHNER, LOU C (OD)
Entity Type:Individual
Prefix:DR
First Name:LOU
Middle Name:C
Last Name:KUSHNER
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 1:457 W 50TH ST APT 4W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6529
Mailing Address - Country:US
Mailing Address - Phone:212-678-0937
Mailing Address - Fax:
Practice Address - Street 1:425 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3903
Practice Address - Country:US
Practice Address - Phone:212-986-9281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11546TPA152W00000X
NYVUT006286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist