MEDICARE: KENNETH A SHUSTER OD

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	03856	NJ
2	152WV0400X	Vision Therapy Optometrist	24500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0613460002	OTHER	NJ	OTHER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821074923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH A SHUSTER OD

Provider Business Mailing Address
First Line	:	4827 ATLANTIC AVE
Second Line	:
City	:	VENTNOR
State	:	NJ
Zip	:	08406-3004
Country	:	US
Telephone Number	:	609-487-0010
Fax Number	:	609-487-0163

Provider Business Practice Location Address
First Line	:	4827 ATLANTIC AVE
Second Line	:
City	:	VENTNOR
State	:	NJ
Zip	:	08406-3004
Country	:	US
Telephone Number	:	609-487-0010
Fax Number	:	609-487-0163

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	07/27/2011

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