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General NPI Number Information
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NPI Number | 1568641439
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Entity Type | Organization
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Legal Business Name | DANIEL L. GAUERKEI DBA BROADWAY VISION CENTER
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 815 W FULTON ST SUITE 103
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City | WAUPACA
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State | WI
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Zip | 54981-1405
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Country | US
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Telephone | 715-258-9122
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Fax | 715-258-3090
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Provider Business Mailing Address
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Address Line | 815 W FULTON ST SUITE 103
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City | WAUPACA
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State | WI
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Zip | 54981-1405
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Country | US
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Telephone | 715-258-9122
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Fax | 715-258-3090
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. HEIDY J GUYER
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Credential |
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Telephone | 715-258-9122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1938
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License Number State | WI
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