Individual
ANTHONY J MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
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
—
P00346769
RAILROAD MEDICARE
PA
Enumeration date
04/27/2006
Last updated
05/25/2011
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