Individual
BRUCE GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1575 20TH ST NW STE 101, FARIBAULT, MN 55021-2931
(507) 332-9900
(507) 332-6800
Mailing address
1575 20TH ST NW STE 101, FARIBAULT, MN 55021-2931
(507) 332-9900
(507) 332-6800
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1651
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00080005
RAILROAD MEDICARE
MN
Enumeration date
07/24/2006
Last updated
11/20/2007
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