Provider Demographics
NPI:1376567198
Name:NARKAUS, GARY A (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:NARKAUS
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 1:500 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2021
Mailing Address - Country:US
Mailing Address - Phone:973-623-5825
Mailing Address - Fax:973-623-2399
Practice Address - Street 1:500 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2021
Practice Address - Country:US
Practice Address - Phone:973-623-5825
Practice Address - Fax:973-623-2399
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA00397000152W00000X
NJTO00018500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3932508Medicaid
NJ521528Medicare ID - Type Unspecified