Provider Demographics
NPI:1679539266
Name:BUSUIOC, MIHAI (OD)
Entity type:Individual
Prefix:DR
First Name:MIHAI
Middle Name:
Last Name:BUSUIOC
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:NY
Mailing Address - Zip Code:12775-6013
Mailing Address - Country:US
Mailing Address - Phone:845-707-4628
Mailing Address - Fax:845-796-3938
Practice Address - Street 1:343 BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1129
Practice Address - Country:US
Practice Address - Phone:845-796-3937
Practice Address - Fax:845-796-3938
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00594500152W00000X
NYTUV006743-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0052752Medicaid
NJ52949OtherDAVIS VISION
NJ28597OtherSPECTERA
NY02529959Medicaid
NJNY6743OtherCOLE VISIONEYEMED
NJ0052752Medicaid
NJ086738Medicare PIN
U99969Medicare UPIN