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General NPI Number Information
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NPI Number | 1447504097
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Entity Type | Organization
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Legal Business Name | STEPHEN E. GUSTAFSON, O.D.
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1388 STONEHOLLOW DR SUITE 1
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City | KINGWOOD
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State | TX
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Zip | 77339-2488
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Country | US
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Telephone | 281-358-5411
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Fax | 281-358-2045
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Provider Business Mailing Address
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Address Line | 1388 STONEHOLLOW DR SUITE 1
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City | KINGWOOD
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State | TX
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Zip | 77339-2488
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Country | US
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Telephone | 281-358-5411
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Fax | 281-358-2045
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID HARMAN STEED
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Credential | O.D.
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Telephone | 281-358-5411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7614TG
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License Number State | TX
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