Provider Demographics
NPI:1700917192
Name:CURSARO, PAOLO ANTONIO (OD)
Entity Type:Individual
Prefix:
First Name:PAOLO
Middle Name:ANTONIO
Last Name:CURSARO
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 1:8742 PAULDEN CT
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7946
Mailing Address - Country:US
Mailing Address - Phone:614-205-9204
Mailing Address - Fax:
Practice Address - Street 1:50 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3301
Practice Address - Country:US
Practice Address - Phone:614-224-8005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH85840Medicare UPIN