MEDICARE: SHERRY LYNN DUSTMAN 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	4901003679	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F38599	OTHER	MI	BLUE CROSS BLUE SHIELD MICHIGAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851336689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY LYNN DUSTMAN O.D.

Provider Business Mailing Address
First Line	:	44555 WOODWARD AVE STE 203
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48341-5033
Country	:	US
Telephone Number	:	248-334-4931
Fax Number	:	248-239-0492

Provider Business Practice Location Address
First Line	:	44555 WOODWARD AVE STE 203
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48341-5033
Country	:	US
Telephone Number	:	248-334-4931
Fax Number	:	248-239-0492

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	09/16/2022

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