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General NPI Number Information
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NPI Number | 1013711399
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Entity Type | Individual
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Provider Name | ISAAC TAYLOR GERHARTZ
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Gender | Male
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 10600 W LAYTON AVE
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City | GREENFIELD
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State | WI
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Zip | 53228-3258
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Country | US
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Telephone | 414-209-0359
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Fax | 414-427-6168
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Provider Business Mailing Address
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Address Line | 2562 S 85TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-2720
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Country | US
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Telephone | 414-304-9542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | ABOC-264958
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License Number State | WI
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