Provider Demographics
NPI:1013711399
Name:GERHARTZ, ISAAC TAYLOR
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:TAYLOR
Last Name:GERHARTZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2562 S 85TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2720
Mailing Address - Country:US
Mailing Address - Phone:414-304-9542
Mailing Address - Fax:
Practice Address - Street 1:10600 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3258
Practice Address - Country:US
Practice Address - Phone:414-209-0359
Practice Address - Fax:414-427-6168
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIABOC-264958156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician