Provider Demographics
NPI:1851402689
Name:GUSTAFSON, BRITT ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:BRITT
Middle Name:ELIZABETH
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:12195 SINGLETREE LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7921
Mailing Address - Country:US
Mailing Address - Phone:952-829-9024
Mailing Address - Fax:952-829-9007
Practice Address - Street 1:12195 SINGLETREE LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7921
Practice Address - Country:US
Practice Address - Phone:952-829-9024
Practice Address - Fax:952-829-9007
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist