MEDICARE: DR. PETER MICHAEL GUSTER 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	3290/T867	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1548263924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER MICHAEL GUSTER O.D.

Provider Business Mailing Address
First Line	:	341 W CHURCH ST
Second Line	:
City	:	ORRVILLE
State	:	OH
Zip	:	44667-1501
Country	:	US
Telephone Number	:	330-682-1276
Fax Number	:	330-682-7219

Provider Business Practice Location Address
First Line	:	341 W CHURCH ST
Second Line	:
City	:	ORRVILLE
State	:	OH
Zip	:	44667-1501
Country	:	US
Telephone Number	:	330-682-1276
Fax Number	:	330-682-7219

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/13/2013

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