Provider Demographics
NPI:1740219948
Name:GUSTIN, SHARI LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:LYNN
Last Name:GUSTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3238
Mailing Address - Country:US
Mailing Address - Phone:585-265-3710
Mailing Address - Fax:585-265-3775
Practice Address - Street 1:81 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-3238
Practice Address - Country:US
Practice Address - Phone:585-265-3710
Practice Address - Fax:585-265-3775
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU32386Medicare UPIN
NYAA1110Medicare ID - Type Unspecified