Provider Demographics
NPI:1396834552
Name:GIESLER, GARY JOHN (OD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JOHN
Last Name:GIESLER
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 1:1150 CLOCK TOWER PLAZA
Mailing Address - Street 2:WASHINGTON EYE CENTER
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090
Mailing Address - Country:US
Mailing Address - Phone:636-239-7722
Mailing Address - Fax:636-239-7622
Practice Address - Street 1:228 EAST FIRST
Practice Address - Street 2:HERMANN EYE CENTER
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041
Practice Address - Country:US
Practice Address - Phone:573-486-3355
Practice Address - Fax:573-486-3355
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42732Medicare UPIN
MO0189060001Medicare NSC