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Contact Information

GARARD M GUSTAFSON, OD
101 MILTON WAY
MILTON, WA98354-8800
 Phone: 253-922-0333
 Fax: 253-922-7322
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for GARARD M GUSTAFSON · (Male)

NPI Number 1114919420
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 08/22/2005
Last updated 05/08/2008 - About 8 years ago
Sole proprietor 1 Yes
Identifiers
WA License # OD00000938
WA Medicaid 2343002
WA Medicare (Unspecified) G001000439 OPTOMETRIST
WA Medicare NSC 0495760001
WA Medicare UPIN T02709
Hospital affiliation(s) n/a
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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