Jennifer Ann Gustafson, O.D.

Primary specialty

Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X

License

007353 Issued in NY

Practice address

150 S Huntington Ave
Boston, MA 02130-4817

Phone

(857) 364-5543

NPI assigned

Jul 7, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1023271418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 S HUNTINGTON AVE # 8B-52",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021304817",
            "telephone_number": "857-364-5543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S HUNTINGTON AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021304817",
            "telephone_number": "857-364-5543"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2094 Albany Post Rd",
            "address_purpose": "LOCATION",
            "city": "Montrose",
            "state": "NY",
            "postal_code": "105481454",
            "country_code": "US",
            "telephone_number": "914-737-4400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2094 Albany Post Rd",
            "address_purpose": "LOCATION",
            "city": "Montrose",
            "state": "NY",
            "postal_code": "105481454",
            "country_code": "US",
            "telephone_number": "914-737-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT 007353",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "NY",
            "license": "007353",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "NY",
            "license": "007353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sofya Gusman
• Tanya Gusovsky, LICSW
• Carly Guss, M.D.
• Daniel Guss, M.D.
• Lauren Guss, LICSW
• Meredith Simpson Gustafson, NP
• Rachel Gustafson, LICSW
• Empress Gustave-Fernandez
• Joseph Patrick Gustin, PMHNP-BC
• Monica Gustin, ACNPC-AG

• Low Vision Rehabilitation Optometrist in Boston, MA
• Providers in Boston, MA by specialty
• Low Vision Rehabilitation Optometrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.