Individual
DR. GARY H. WHEELER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
309 GENESSEE ST, MEDFORD, OR 97504-7107
(541) 779-2095
(541) 779-0667
Mailing address
309 GENESSEE ST, MEDFORD, OR 97504-7107
(541) 779-2095
(541) 779-0667
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1095T
OR
152WC0802X
Corneal and Contact Management Optometrist
1095T
OR
152WL0500X
Low Vision Rehabilitation Optometrist
1095T
OR
152WP0200X
Pediatric Optometrist
1095T
OR
152WS0006X
Sports Vision Optometrist
1095T
OR
152WX0102X
Occupational Vision Optometrist
1095T
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0443320001
MEDICARE SUPPLY PIN
OR
01
—
A003
TRICARE
OK
Enumeration date
10/14/2005
Last updated
12/04/2007
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