Provider Demographics
NPI:1669523791
Name:GERBER, MICHEAL DEAN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:DEAN
Last Name:GERBER
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:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-0228
Mailing Address - Country:US
Mailing Address - Phone:920-361-1696
Mailing Address - Fax:920-361-1247
Practice Address - Street 1:269 MEMORIAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923
Practice Address - Country:US
Practice Address - Phone:920-361-1696
Practice Address - Fax:920-361-1247
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2681-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38601400Medicaid
WI000047680 002Medicare ID - Type Unspecified
WI38601400Medicaid