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Individual

DR. RYAN CHRISTOPHER GUSTUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
980 N MAIN ST, BLUFFTON, IN 46714-1316
(260) 824-2020
Mailing address
927 WILLEN LN, FORT WAYNE, IN 46818-8405
(260) 348-3949

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003688A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100389250
IN
Enumeration date
07/19/2011
Last updated
05/15/2013
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