Provider Demographics
NPI:1043251812
Name:BIRKMANN, GERALD PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:PAUL
Last Name:BIRKMANN
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 1:1 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-1304
Mailing Address - Country:US
Mailing Address - Phone:636-239-1589
Mailing Address - Fax:
Practice Address - Street 1:30 W HIGHWAY D
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW MELLE
Practice Address - State:MO
Practice Address - Zip Code:63365-9998
Practice Address - Country:US
Practice Address - Phone:636-828-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist