Provider Demographics
NPI:1447318340
Name:BUSCH, GARY DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:DAVID
Last Name:BUSCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 INDIAN RIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3280
Mailing Address - Country:US
Mailing Address - Phone:937-320-0300
Mailing Address - Fax:937-320-0500
Practice Address - Street 1:4248 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3280
Practice Address - Country:US
Practice Address - Phone:937-320-0300
Practice Address - Fax:937-320-0500
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0429532Medicare PIN
OHT46827Medicare UPIN