Organization
ANTHONY J. MANCUSO, OD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARTINA ANN MANCUSO (OFFICE MANAGER)
(724) 459-6610
Entity
Organization
Contact information
Practice address
155 E MARKET ST, SUITE 2, BLAIRSVILLE, PA 15717-1357
(724) 459-6610
(724) 459-6630
Mailing address
155 E MARKET ST, SUITE 2, BLAIRSVILLE, PA 15717-1357
(724) 459-6610
(724) 459-6630
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000818
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DF2054
RAILROAD MEDICARE
PA
Enumeration date
04/26/2006
Last updated
01/13/2015
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