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NPI Code Detail

MEDICARE: MARK SHERSTINSKY O.D.

MEDICARE: MARK SHERSTINSKY O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristVUT006400NY
2152W00000XOptometrist11397TX
3152W00000XOptometrist12180TLGCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053392696
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK SHERSTINSKY O.D.
Provider Business Mailing Address
First Line : 3916 S BROADWAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90037-1307
Country : US
Telephone Number : 323-234-9137
Fax Number : 323-235-6203
Provider Business Practice Location Address
First Line : 915 GESSNER RD STE 100
Second Line :
City : HOUSTON
State : TX
Zip : 77024-2537
Country : US
Telephone Number : 713-242-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 12/08/2025

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