Healthcare Provider Details

I. General information

NPI: 1679009310
Provider Name (Legal Business Name): ALEXANDER RAYMOND SHUSKO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10555 N 114TH ST STE 103
SCOTTSDALE AZ
85259-4940
US

IV. Provider business mailing address

10555 N 114TH ST STE 103
SCOTTSDALE AZ
85259-4940
US

V. Phone/Fax

Practice location:
  • Phone: 623-307-7699
  • Fax: 623-307-7700
Mailing address:
  • Phone: 623-307-7699
  • Fax: 623-307-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA172535
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number66619
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number66619
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License NumberA172535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: