Gary John Burkhardt, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1989035 Issued in WI

Practice address

19 W Main St
Chilton, WI 53014-1323

Phone

(920) 849-4291

Fax

(920) 849-4292

NPI assigned

Dec 26, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Corr Opticians Inc

  • Optician
  • Neenah, WI
  • NPI 1336101161

  Optometrist

  NPD (past)
• Kimberly Eye Clinic Inc

  • Optometrist
  • Kimberly, WI
  • NPI 1912983370
  NPD (past)
• Packerland Eyecare, LLC

  • Optometrist
  • Appleton, WI
  • NPI 1922678200
  NPD (past)
• Romenesko Family Eyecare LLC

  • Optometrist
  • Neenah, WI
  • NPI 1154972321
  NPD (past)
• Valley Vision Clinic SC

  • Optometrist
  • Neenah, WI
  • NPI 1477522324
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359331200000",
    "number": "1861479412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 W MAIN ST",
            "city": "CHILTON",
            "state": "WI",
            "postal_code": "530141323",
            "telephone_number": "920-849-4291",
            "fax_number": "920-849-4292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 W MAIN ST",
            "city": "CHILTON",
            "state": "WI",
            "postal_code": "530141323",
            "telephone_number": "920-849-4291",
            "fax_number": "920-849-4292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKHARDT",
        "first_name": "GARY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-26",
        "last_updated": "2013-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1989035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38588600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Baycare Clinic, LLP
• Andrew Beine, MD
• Christopher H Berkers, DMD
• Katherine Elizabeth Bieda, PT
• Christine M Bockhorn, MD
• Calumet County
• Calumet County
• Calumet County
• Calumet County
• Calumet County

• All providers in Chilton, WI
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.