Provider Demographics
NPI:1295835700
Name:GAUERKE, DANIEL L (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:GAUERKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W FULTON ST STE 3
Mailing Address - Street 2:P.O. BOX 437
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1405
Mailing Address - Country:US
Mailing Address - Phone:715-258-9122
Mailing Address - Fax:715-258-3090
Practice Address - Street 1:815 W FULTON ST STE 3
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1405
Practice Address - Country:US
Practice Address - Phone:715-258-9122
Practice Address - Fax:715-258-3090
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
47285Medicare ID - Type Unspecified
WIT61978Medicare UPIN