Individual
DR. STEPHEN VINCENT CUSUMANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2681 HIGHWAY K, O FALLON, MO 63368-7865
(636) 978-5555
(636) 978-5555
Mailing address
9979 WINGHAVEN BLVD STE 210, O FALLON, MO 63368-3628
(636) 695-8555
(636) 695-8555
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO2670
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831192533
NPI
—
01
—
431081796
FEDERAL TAX ID
MO
01
—
91710001
PTAN
—
Enumeration date
05/27/2005
Last updated
10/20/2025
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