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General NPI Number Information
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NPI Number | 1962512533
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Entity Type | Organization
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Legal Business Name | MARK A SHUST OD
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 121 KREWSON LANE
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City | CHELTENHAM
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State | PA
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Zip | 19012-1202
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Country | US
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Telephone | 215-588-8371
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Fax | 215-379-1850
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Provider Business Mailing Address
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Address Line | 121 KREWSON LANE
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City | CHELTENHAM
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State | PA
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Zip | 19012-1202
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Country | US
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Telephone | 215-588-8371
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Fax | 215-379-1850
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | MARK SHUST
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Credential | OD
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Telephone | 215-588-8371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG000935
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License Number State | PA
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