Gustafson, Terry John
Gustafson, Terry John is an sole proprietor health care provider with primary practice located at 17416 Pacific Ave S , Spanaway WA 98387-8263. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Gustafson, Terry John can be contacted via phone (253) 531-1388.Contact Information
Primary practice address
17416 Pacific Ave S
Spanaway WA 98387-8263
Phone: (253) 531-1388
Fax: (253) 531-1460
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1084 | Washington |
Profile Details
| NPI number | 1932197407 |
|---|---|
| LBN Legal business name | Gustafson, Terry John |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 10th, 2005 |
| Last updated | Jan 27th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932197407 | NPPES |
| Washington | MEDICAID | 2008704 | |
| Washington | Other | 22875 |
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