Provider Demographics
NPI:1447331004
Name:GAETA, DENNIS MARTIN (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MARTIN
Last Name:GAETA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:17730 OAK PARK AVE
Mailing Address - Street 2:UNIT B1
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3918
Mailing Address - Country:US
Mailing Address - Phone:708-614-2311
Mailing Address - Fax:708-614-2087
Practice Address - Street 1:17730 OAK PARK AVE
Practice Address - Street 2:UNIT B1
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3918
Practice Address - Country:US
Practice Address - Phone:708-614-2311
Practice Address - Fax:708-614-2087
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL046008113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist