Burkhardt, Gary John
Burkhardt, Gary John is an sole proprietor health care provider with primary practice located at 19 W Main St , Chilton WI 53014-1323. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Burkhardt, Gary John can be contacted via phone (920) 849-4291.Contact Information
Primary practice address
19 W Main St
Chilton WI 53014-1323
Phone: (920) 849-4291
Fax: (920) 849-4292
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1989035 | Wisconsin |
Profile Details
| NPI number | 1861479412 |
|---|---|
| LBN Legal business name | Burkhardt, Gary John |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 26th, 2005 |
| Last updated | Jan 28th, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861479412 | NPPES |
| Wisconsin | MEDICAID | 38588600 |
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