Provider Demographics
NPI:1154757169
Name:CUSSATT, JOSEPH D
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:D
Last Name:CUSSATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1551
Mailing Address - Country:US
Mailing Address - Phone:570-455-1100
Mailing Address - Fax:570-455-1101
Practice Address - Street 1:601 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WEST HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1551
Practice Address - Country:US
Practice Address - Phone:570-455-1100
Practice Address - Fax:570-455-1101
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens