Basic Information
| Provider Information | |||||||||
| NPI: | 1558327742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUSSE | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 MAPLE RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142213260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166318888 | ||||||||
| FaxNumber: | 7166313803 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 MAPLE RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142213260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166318888 | ||||||||
| FaxNumber: | 7166313803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 182572-2 | NY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 01566650 | 05 | NY | MEDICAID | 161000580 | 01 | NY | NORTH AMERICAN PREFERRED | OTHER | 0807280 | 01 | NY | IHA | OTHER | 161000580 | 01 | NY | EMPIRE | OTHER | 0021748 | 01 | NY | GHI | OTHER | 182572-8B | 01 | NY | WORKERS COMPENSATION | OTHER | 00010049101 | 01 | NY | UNIVERA | OTHER | 180023659 | 01 | NY | RR MEDICARE | OTHER | 000523681001 | 01 | NY | HEALTH NOW | OTHER |