MEDICARE: DR. DAVID GARY JAMES 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	1673-035	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	:	1780667204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID GARY JAMES O.D.

Provider Business Mailing Address
First Line	:	17727 W DREAMVIEW CT
Second Line	:
City	:	BROOKLYN
State	:	WI
Zip	:	53521-9662
Country	:	US
Telephone Number	:	608-455-1005
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 W NETHERWOOD RD
Second Line	:
City	:	OREGON
State	:	WI
Zip	:	53575-1100
Country	:	US
Telephone Number	:	608-835-3579
Fax Number	:

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	01/04/2011

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