Provider Demographics
NPI:1942212717
Name:SHUST, MARK A (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:SHUST
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 KREWSON LN
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1202
Mailing Address - Country:US
Mailing Address - Phone:215-379-1850
Mailing Address - Fax:
Practice Address - Street 1:121 KREWSON LN
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-1202
Practice Address - Country:US
Practice Address - Phone:215-379-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0470321000OtherKEYSTONE EAST
PA2248OtherAETNA HMO
PA1684739OtherBLUE SHIELD
PA0470321000OtherKEYSTONE EAST
PA1684739OtherBLUE SHIELD