Provider Demographics
NPI:1962451229
Name:GUTSCHENRITTER, JOHN JEFFREY I (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JEFFREY
Last Name:GUTSCHENRITTER
Suffix:I
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 1:1225 S POPLAR ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-7785
Mailing Address - Country:US
Mailing Address - Phone:308-534-7638
Mailing Address - Fax:
Practice Address - Street 1:1225 S POPLAR ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-7785
Practice Address - Country:US
Practice Address - Phone:308-534-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0779548-13Medicaid
NE10025551000Medicaid
NET89784Medicare UPIN
NE158106Medicare UPIN
NE6181290001Medicare NSC
NE10025551000Medicaid