MEDICARE: DR. GARY DAVID BUSCH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3161	OH

General Provider Information

NPI Number	:	1447318340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY DAVID BUSCH O.D.

Provider Business Mailing Address
First Line	:	4248 INDIAN RIPPLE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3280
Country	:	US
Telephone Number	:	937-320-0300
Fax Number	:	937-320-0500

Provider Business Practice Location Address
First Line	:	4248 INDIAN RIPPLE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3280
Country	:	US
Telephone Number	:	937-320-0300
Fax Number	:	937-320-0500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	02/19/2008

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