Provider Demographics
NPI:1831759810
Name:A DUSSAN SERVICES LLC
Entity type:Organization
Organization Name:A DUSSAN SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUSSAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:347-242-3884
Mailing Address - Street 1:1016 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-6273
Mailing Address - Country:US
Mailing Address - Phone:516-792-6901
Mailing Address - Fax:
Practice Address - Street 1:1016 50TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-6273
Practice Address - Country:US
Practice Address - Phone:516-792-6901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03487065Medicaid