Individual
DR. TERRY JOHN GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1084
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2008704
—
WA
01
—
22875
DEPT OF L & I
WA
Enumeration date
10/10/2005
Last updated
01/27/2009
Update your record
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