Provider Demographics
NPI:1518080266
Name:SAXERUD, GAIL E (OD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:E
Last Name:SAXERUD
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 1:2120 KITTRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3856
Mailing Address - Country:US
Mailing Address - Phone:719-591-7818
Mailing Address - Fax:
Practice Address - Street 1:15435 GLENEAGLE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2502
Practice Address - Country:US
Practice Address - Phone:719-660-1432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2475152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTU62362Medicare UPIN