MEDICARE: GERAETS VISION CENTER, INC

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	1803	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508042730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERAETS VISION CENTER, INC

Provider Business Mailing Address
First Line	:	2704 N PONTIAC DR
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-0343
Country	:	US
Telephone Number	:	608-758-2020
Fax Number	:	608-755-7604

Provider Business Practice Location Address
First Line	:	2704 N PONTIAC DR
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-0343
Country	:	US
Telephone Number	:	608-758-2020
Fax Number	:	608-755-7604

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MELISSA SCALISSI
Credential	:	ABOC
Telephone Number	:	608-758-2020

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/06/2012

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Directions to “GERAETS VISION CENTER, INC ” Practice Location

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