Healthcare Provider Details

I. General information

NPI: 1225227135
Provider Name (Legal Business Name): MICHAEL E GEWE OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E ELM ST
NASHVILLE IL
62263-1710
US

IV. Provider business mailing address

250 E ELM ST
NASHVILLE IL
62263-1710
US

V. Phone/Fax

Practice location:
  • Phone: 618-327-3231
  • Fax: 618-327-8748
Mailing address:
  • Phone: 618-327-3231
  • Fax: 618-327-8748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046006845
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL EUGENE GEWE
Title or Position: PRESIDENT
Credential: O.D.
Phone: 618-327-3231