Provider Demographics
NPI:1649359522
Name:LUSK, WIBERT CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:WIBERT
Middle Name:CHARLES
Last Name:LUSK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 LAKEVIEW DR N
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-3001
Mailing Address - Country:US
Mailing Address - Phone:607-547-8253
Mailing Address - Fax:607-547-8253
Practice Address - Street 1:5024 STATE HIGHWAY 23
Practice Address - Street 2:WALMART VISON CENTER
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820
Practice Address - Country:US
Practice Address - Phone:607-433-4776
Practice Address - Fax:607-433-4695
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002556-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist