Provider Demographics
NPI:1548263924
Name:GUSTER, PETER MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:GUSTER
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 1:341 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-1501
Mailing Address - Country:US
Mailing Address - Phone:330-682-1276
Mailing Address - Fax:330-682-7219
Practice Address - Street 1:341 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1501
Practice Address - Country:US
Practice Address - Phone:330-682-1276
Practice Address - Fax:330-682-7219
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3290/T867152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0337246Medicaid
OH0337246Medicaid
OH0463770001Medicare NSC
OHGU0459262Medicare ID - Type Unspecified