Active NPI
Michelle Gustin, OD
- Optometrist
- Green Bay, WI
National Provider Identifier
1336106939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2624
- Practice address
- 2158 W Mason St
Green Bay, WI 54303-4705 - Phone
- (920) 490-9860
- NPI assigned
- Apr 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2624 | WI | Primary |
Addresses
Primary practice location
2158 W Mason St
Green Bay, WI 54303-4705
Mailing address
418 Patricia LN
Wrightstown, WI 54180-1207
Phone (920) 532-0537
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2624 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199318400000",
"number": "1336106939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "418 PATRICIA LN",
"city": "WRIGHTSTOWN",
"state": "WI",
"postal_code": "541801207",
"telephone_number": "920-532-0537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2158 W MASON ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543034705",
"telephone_number": "920-490-9860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTIN",
"first_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-27",
"last_updated": "2008-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "2624",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.