Healthcare Provider Details

I. General information

NPI: 1689599730
Provider Name (Legal Business Name): GIDEON CAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 JONES ST.
APO AA
58205-6332
US

IV. Provider business mailing address

W61N953 CRESCENT DR
CEDARBURG WI
53012-1227
US

V. Phone/Fax

Practice location:
  • Phone: 701-747-5601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number416235
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: