DR. DWANE R GUSTAFSON (NPI# 1861441818) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861441818 |
| Entity Type | Individual |
| Full Name | DR. DWANE R GUSTAFSON |
| Credential | O.D. |
| Practice Address |
1801 19th Ave Sw Willmar MN 56201-4946 |
| Practice Telephone | 3202352020 |
| Practice Fax Number | 3202145761 |
| Mailing Telephone | 3202352020 |
| Mailing Fax Number | 3202145761 |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2008-01-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
1514 | MN | Eye and Vision Services Providers |
| Street Address |
1801 19TH AVE SW |
| City | WILLMAR |
| State | MN |
| Zip Code | 56201-4946 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386693604 | Jeffrey L Fischer | Optometrist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2006-05-06 |
| 1760966758 | Megan Katherine Murphy | Physician Assistant | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2018-09-17 |
| 1073004289 | Whitney Stock | Optometrist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2018-05-23 |
| 1366977936 | Kristen Dargay | Audiologist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2017-04-20 |
| 1386081065 | Jennifer Lynn Fairbanks | Optometrist | 1801 19th Ave Sw, Willmar, MN 56201 | 2013-06-04 |
| 1386990315 | Kara Degroot | Nurse Practitioner | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2012-07-27 |
| 1366752248 | Shane Jahraus | Optometrist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2010-10-13 |
| 1093997843 | Thomas J Lenz | Optometrist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2007-12-04 |
| 1396963922 | Martin Heinz Janning | Otolaryngology | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2007-04-20 |
| 1275615445 | Audiology Center Inc. | Audiologist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2006-10-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730793472 | Sarah Erickson | Counselor | 2120 60th Ave N.w., Willmar, MN 56201 | 2020-09-01 |
| 1417560681 | Amy Engle | Nurse Practitioner | 1125 Se 8th Street, Willmar, MN 56201 | 2020-08-28 |
| 1154856524 | Mude Transportation Inc | Non-emergency Medical Transport (VAN) | 1712 Monongalia Ave Sw Ap1, Willmar, MN 56201 | 2017-04-24 |
| 1285025874 | Jill Fellows | Occupational Therapist | 611 5th St. Sw, Willmar, MN 56201 | 2015-02-18 |
| 1700294881 | Brenda Wiese | Counselor | 1617 Hwy 12 E, Suite 230, Willmar, MN 56201 | 2014-08-01 |
| 1275955932 | Courtney Regnier | Marriage & Family Therapist | 2320 E Hwy 12 Ste 2, Willmar, MN 56201 | 2014-01-15 |
| 1568732402 | Pamela Jean Kubesh | Social Worker | 328 Sw 3rd Street, Willmar, MN 56201 | 2012-01-10 |
| 1699931824 | Community Behavioral Health Hospital-willmar | Psychiatric Hospital | 1208 Olena Ave Se, Willmar, MN 56201 | 2008-08-07 |
| 1700053345 | Nathan Schrick | Marriage & Family Therapist | 513 Sw 5th Street, Box 1810, Willmar, MN 56201 | 2008-05-13 |
| 1831381680 | Joan M Blonigan Christianson | Chiropractor | 1101 S 1st Street, Willmar, MN 56201 | 2007-08-15 |
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| Taxonomy Code | 152WC0802X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Specialization | Corneal and Contact Management |
| The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea’s ability to sustain successful contact lens wear, and treatment of any external eye or corneal condition which can affect contact lens wear. |
| Notes: Source: American Optometric Association [1/1/2009: added definition, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386693604 | Jeffrey L Fischer | Optometrist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2006-05-06 |
| 1093997843 | Thomas J Lenz | Optometrist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2007-12-04 |
| 1548219512 | Michael A Nagel | Optometrist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2006-05-08 |
| 1558310623 | Fischer Laser Eye Center LLC | Optometrist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2006-05-08 |
| 1265481212 | Michael L Novak | Optometrist | 1801 19th Ave Sw, Willmar, MN 56201-4946 | 2006-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265953608 | Fischer Laser Eye Center, LLC | Optometrist | 1380 E Bridge St Ste B, Redwood Falls, MN 56283-1904 | 2017-07-06 |
| 1851842660 | Fischer Laser Eye Center, LLC | Optometrist | 1805 Minnesota Ave, Suite 2, Benson, MN 56215-1778 | 2016-10-17 |
| 1467836650 | Pinecone Vision Center | Optometrist | 2180 Troop Drive, Sartell, MN 56377-4563 | 2015-07-17 |
| 1639292147 | Robert C. Dinga | Optometrist | 8344 3rd Street North, Oakdale, MN 55128 | 2007-04-09 |
| 1275626731 | Byron K Fleck | Optometrist | 4740 Mall Drive, Hermantown, MN 55811 | 2006-10-02 |
| 1831290550 | Thomas Nelson Johnson | Optometrist | 2824 W Division St, Saint Cloud, MN 56301-3800 | 2006-09-26 |
| 1124033782 | Erin Troy Bremner | Optometrist | 38 E Harvey St, Ely, MN 55731-1240 | 2006-07-30 |
| 1154343176 | Sanford Clinic North | Optometrist | 20 W Centennial 84 Drive, New York Mills, MN 56567-0364 | 2006-07-25 |
| 1295784338 | Fischer Laser Eye Center, LLC | Optometrist | 115 Washburne Ave, Paynesville, MN 56362-1640 | 2006-05-08 |
| 1942258413 | Fischer Laser Eye Center, LLC | Optometrist | 1815 W Lincoln Ave, Olivia, MN 56277-1271 | 2006-05-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.