Provider Demographics
NPI:1447504097
Name:STEPHEN E. GUSTAFSON, O.D.
Entity type:Organization
Organization Name:STEPHEN E. GUSTAFSON, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HARMAN
Authorized Official - Last Name:STEED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-358-5411
Mailing Address - Street 1:1388 STONEHOLLOW DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2488
Mailing Address - Country:US
Mailing Address - Phone:281-358-5411
Mailing Address - Fax:281-358-2045
Practice Address - Street 1:1388 STONEHOLLOW DR
Practice Address - Street 2:SUITE 1
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2488
Practice Address - Country:US
Practice Address - Phone:281-358-5411
Practice Address - Fax:281-358-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7614TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMG0266115OtherDEA
TXMG0266115OtherDEA