Individual
DR. TERRY JOHN GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
17416 PACIFIC AVE S, SPANAWAY, WA 98387-8263
(253) 531-1388
(253) 531-1460
Mailing address
17416 PACIFIC AVE SO, SPANAWAY, WA 98387-0728
(253) 531-1388
(253) 531-1460
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
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