Organization
CARL A GUSTAFSON, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL GUSTAFSON (OWNER)
(781) 335-1166
Entity
Organization
Contact information
Practice address
649 BROAD ST, WEYMOUTH, MA 02189-2041
(781) 335-1166
Mailing address
649 BROAD ST, WEYMOUTH, MA 02189-2041
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MA2132
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110012664A
—
MA
Enumeration date
03/26/2010
Last updated
03/26/2010
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