Provider Demographics
NPI:1427117662
Name:GUST, KAREN ANN (OD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:GUST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:DELSERONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2384 FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101
Mailing Address - Country:US
Mailing Address - Phone:412-486-1043
Mailing Address - Fax:412-486-5619
Practice Address - Street 1:2384 FERGUSON RD
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101
Practice Address - Country:US
Practice Address - Phone:412-486-1043
Practice Address - Fax:412-486-5619
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000710152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA368587OtherHIGHMARK BLUE CROSS
PA410049150OtherRAILROAD MEDICARE
PA4741440001Medicare NSC
PA368587OtherHIGHMARK BLUE CROSS
PA436393Medicare PIN
PAU12839Medicare UPIN