Organization
JOANNA KUSHON O.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOANNA CAROLE KUSHON O.D. (OWNER)
(757) 340-9680
Entity
Organization
Contact information
Practice address
3590 HOLLAND RD, SUITE 104, VIRGINIA BEACH, VA 23452-4053
(757) 340-9680
(757) 463-5496
Mailing address
3590 HOLLAND RD, SUITE 104, VIRGINIA BEACH, VA 23452-4053
(757) 340-9680
(757) 463-5496
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001249
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010129265
—
VA
01
—
C10476
MEDICARE GROUP PTAN
VA
Enumeration date
12/13/2006
Last updated
12/09/2009
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