Provider Demographics
NPI:1043470677
Name:GESS EYE CLINIC P.A.
Entity Type:Organization
Organization Name:GESS EYE CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GESS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-762-5112
Mailing Address - Street 1:109 15TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2512
Mailing Address - Country:US
Mailing Address - Phone:320-762-5112
Mailing Address - Fax:320-763-3297
Practice Address - Street 1:109 15TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2512
Practice Address - Country:US
Practice Address - Phone:320-762-5112
Practice Address - Fax:320-763-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN077023000Medicaid
2200883OtherMEDICA
MN48G30GEOtherBLUE CROSS BLUE SHIELD
MN48G31GEOtherBLUE CROSS BLUE SHIELD
T65538OtherUNICARE
T65538OtherUNICARE
MN48G31GEOtherBLUE CROSS BLUE SHIELD
MN48G30GEOtherBLUE CROSS BLUE SHIELD
MNT65538Medicare UPIN