Jason Gospodarek, OD
Individual provider Active NPI Optometrist · Oneida, WI
NPI 1821086455 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1821086455
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2863-035 (WI)
- Practice address
- 525 Airport Dr
Oneida, WI 54155-9035 - Phone
- (920) 869-2711
- NPI assigned
- Oct 7, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2863-035 | WI | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2863-035 | WI | Yes |
Addresses
Primary practice location
525 Airport Dr
Oneida, WI 54155-9035
Mailing address
PO Box 365
Oneida, WI 54155-0365
Phone (920) 869-2711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 721697 | Other | WI | MANAGED HEALTH SERVICE |
| 38614900 | Medicaid | WI |
Other providers in Oneida, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.