Provider Demographics
NPI:1245375716
Name:AXIN TUSSY, AURORA (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:AURORA
Middle Name:
Last Name:AXIN TUSSY
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 W 239TH ST
Mailing Address - Street 2:#1A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1258
Mailing Address - Country:US
Mailing Address - Phone:718-601-4930
Mailing Address - Fax:
Practice Address - Street 1:679 W 239TH ST
Practice Address - Street 2:#1A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1258
Practice Address - Country:US
Practice Address - Phone:718-601-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005642-1152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation