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General NPI Number Information
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NPI Number | 1497735864
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Entity Type | Individual
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Provider Name | JAMES JOSEPH GERAETS O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 2704 N PONTIAC DR
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City | JANESVILLE
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State | WI
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Zip | 53545-0343
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Country | US
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Telephone | 608-758-2020
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Fax | 608-755-7604
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Provider Business Mailing Address
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Address Line | 1009 THORNECREST DR
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City | JANESVILLE
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State | WI
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Zip | 53546-1789
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Country | US
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Telephone | 608-756-9314
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Fax | 608-755-7604
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1803
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License Number State | WI
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