Individual
DR. JENNIFER ANN GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
150 S HUNTINGTON AVE, BOSTON, MA 02130-4817
(857) 364-5543
Mailing address
150 S HUNTINGTON AVE # 8B-52, BOSTON, MA 02130-4817
(857) 364-5543
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
VUT 007353
NY
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
007353
NY
152WV0400X
Vision Therapy Optometrist
007353
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/07/2008
Last updated
03/17/2018
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