Provider Demographics
NPI:1679556146
Name:SHURMINSKY, WALTER JOHN JR (OD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JOHN
Last Name:SHURMINSKY
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18 FAWN HILL DR
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2829
Mailing Address - Country:US
Mailing Address - Phone:201-934-7317
Mailing Address - Fax:
Practice Address - Street 1:420 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1635
Practice Address - Country:US
Practice Address - Phone:973-667-0331
Practice Address - Fax:973-667-9673
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00467800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU26929Medicare UPIN
521630Medicare PIN