Terry John Gustafson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1084 Issued in WA

Practice address

17416 Pacific Ave S
Spanaway, WA 98387-8263

Phone

(253) 531-1388

Fax

(253) 531-1460

NPI assigned

Oct 10, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233014400000",
    "number": "1932197407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17416 PACIFIC AVE SO",
            "city": "SPANAWAY",
            "state": "WA",
            "postal_code": "983870728",
            "telephone_number": "253-531-1388",
            "fax_number": "253-531-1460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17416 PACIFIC AVE S",
            "city": "SPANAWAY",
            "state": "WA",
            "postal_code": "983878263",
            "telephone_number": "253-531-1388",
            "fax_number": "253-531-1460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "TERRY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2009-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2008704",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L & I",
            "identifier": "22875",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Green, SLP
• Cheryl Greenland
• Monica Grewal, LMFTA
• Ramandeep Grewal, PHARMD
• Latosha Grimes
• Jamie Gutierrez, LMT
• Jennifer Haggard, SLP-ASSISTANT
• Julia Grace Hallinan, LMP
• Erik Hammil, COTA
• Marjorie Lorraine Hamrick, LMP

• Optometrist in Spanaway, WA
• Providers in Spanaway, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; 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.