Provider Demographics
NPI:1497735864
Name:GERAETS, JAMES JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:GERAETS
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 1:1009 THORNECREST DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-1789
Mailing Address - Country:US
Mailing Address - Phone:608-756-9314
Mailing Address - Fax:608-755-7604
Practice Address - Street 1:2704 N PONTIAC DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0343
Practice Address - Country:US
Practice Address - Phone:608-758-2020
Practice Address - Fax:608-755-7604
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38520300Medicaid
WI000047248Medicare PIN
WI38520300Medicaid
WIWI12544001Medicare PIN
WI4483300001Medicare NSC
WIU30941Medicare UPIN