MEDICARE: KENNETH A GIUSTO 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
1	152W00000X	Optometrist	5862-T2776	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00823294	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000633789	OTHER	OH	ANTHEM
2	5862-T2776	OTHER	OH	OHIO LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083846943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH A GIUSTO O.D.

Provider Business Mailing Address
First Line	:	518 WEST AVE
Second Line	:
City	:	TALLMADGE
State	:	OH
Zip	:	44278-2117
Country	:	US
Telephone Number	:	330-630-9699
Fax Number	:	330-630-2173

Provider Business Practice Location Address
First Line	:	3510 MANCHESTER RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-1415
Country	:	US
Telephone Number	:	330-630-9699
Fax Number	:	330-644-0187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2009
Last Update Date	:	05/24/2012

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