Provider Demographics
NPI:1902475809
Name:SHUST, VICTORIA (OD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SHUST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1018 W 9TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1225
Mailing Address - Country:US
Mailing Address - Phone:610-337-1580
Mailing Address - Fax:610-337-2133
Practice Address - Street 1:1018 W 9TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1225
Practice Address - Country:US
Practice Address - Phone:610-337-1580
Practice Address - Fax:610-337-2133
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist