Individual
DAVID G GAUSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 S MILL ST, SUITE 2, FERGUS FALLS, MN 56537-2756
(218) 998-2020
(218) 998-2098
Mailing address
2930 LAKEWOOD DR, FERGUS FALLS, MN 56537-3948
(218) 736-4089
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
025206
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4C853GA
BLUE CROSS BLUE SHIELD OF MN
MN
Enumeration date
11/18/2009
Last updated
11/18/2009
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