Organization
CUSUMANO VISION CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN VINCENT CUSUMANO O.D. (PRESIDENT)
(636) 391-3937
Entity
Organization
Contact information
Practice address
317 CLARKSON RD, ELLISVILLE, MO 63011-2271
(636) 391-3937
Mailing address
317 CLARKSON RD, ELLISVILLE, MO 63011-2271
(636) 391-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO2670
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000091171
PTAN
—
01
—
1578718789
NPI
—
Enumeration date
12/02/2008
Last updated
02/17/2010
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