MEDICARE: MARK A SHUNTA 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	4901002766	MI

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
2	MS002766	OTHER		BCBSM

General Provider Information

NPI Number	:	1588775175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A SHUNTA OD

Provider Business Mailing Address
First Line	:	499 W NORTON AVE
Second Line	:
City	:	MUSKEGON HTS
State	:	MI
Zip	:	49444
Country	:	US
Telephone Number	:	231-733-2685
Fax Number	:	231-737-1236

Provider Business Practice Location Address
First Line	:	499 W NORTON AVE
Second Line	:
City	:	MUSKEGON HTS
State	:	MI
Zip	:	49444
Country	:	US
Telephone Number	:	231-733-2685
Fax Number	:	231-737-1236

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/05/2015

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Directions to “ MARK A SHUNTA OD” Practice Location

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