Provider Demographics
NPI:1083846943
Name:GIUSTO, KENNETH A (OD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:A
Last Name:GIUSTO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2117
Mailing Address - Country:US
Mailing Address - Phone:330-630-9699
Mailing Address - Fax:330-630-2173
Practice Address - Street 1:3510 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1415
Practice Address - Country:US
Practice Address - Phone:330-630-9699
Practice Address - Fax:330-644-0187
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5862-T2776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000633789OtherANTHEM
OH5862-T2776OtherOHIO LICENSE
OH2988343Medicaid
OHP00823294OtherRAILROAD MEDICARE
OHP00823294OtherRAILROAD MEDICARE