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NPI Code Detail

MEDICARE: DR. JAMES ROBERT GUTFLEISCH O.D.

MEDICARE: DR. JAMES ROBERT GUTFLEISCH 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
1152W00000XOptometristLD1848000MN
2152WC0802XCorneal and Contact Management OptometristLD1848000MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1177K2GUOTHERMNBLUE CROSS BLUE SHIELD MN
2526004OTHERMNAMERICA'S PPO
3106257OTHERMNU CARE, MN
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982600524
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES ROBERT GUTFLEISCH O.D.
Provider Business Mailing Address
First Line : 710 DIVISION ST S
Second Line : STE A
City : NORTHFIELD
State : MN
Zip : 55057-2468
Country : US
Telephone Number : 507-645-2261
Fax Number : 507-786-9703
Provider Business Practice Location Address
First Line : 710 DIVISION ST-SOUTH
Second Line : SUITE A
City : NORTHFIELD
State : MN
Zip : 55057-2468
Country : US
Telephone Number : 507-645-2261
Fax Number : 507-786-9703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 07/26/2010

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