Provider Demographics
NPI:1982600524
Name:GUTFLEISCH, JAMES ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:GUTFLEISCH
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 1:710 DIVISION ST S
Mailing Address - Street 2:STE A
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2468
Mailing Address - Country:US
Mailing Address - Phone:507-645-2261
Mailing Address - Fax:507-786-9703
Practice Address - Street 1:710 DIVISION ST-SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2468
Practice Address - Country:US
Practice Address - Phone:507-645-2261
Practice Address - Fax:507-786-9703
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLD1848000152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN177K2GUOtherBLUE CROSS BLUE SHIELD MN
MN526004OtherAMERICA'S PPO
MN106257OtherU CARE, MN
MN6463231-00Medicaid
MN526004OtherAMERICA'S PPO
MN6463231-00Medicaid
MN177K2GUOtherBLUE CROSS BLUE SHIELD MN