MEDICARE: DR. GERALD PAUL BIRKMANN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TO2148	MO

General Provider Information

NPI Number	:	1043251812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD PAUL BIRKMANN O.D.

Provider Business Mailing Address
First Line	:	1 LAURA LN
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-1304
Country	:	US
Telephone Number	:	636-239-1589
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 W HIGHWAY D
Second Line	:	SUITE 200
City	:	NEW MELLE
State	:	MO
Zip	:	63365-9998
Country	:	US
Telephone Number	:	636-828-4733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	10/12/2007

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