Individual
DR. JASON GOSPODAREK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
525 AIRPORT DR, ONEIDA, WI 54155-9035
(920) 869-2711
Mailing address
PO BOX 365, ONEIDA, WI 54155-0365
(920) 869-2711
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2863-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38614900
—
WI
01
—
721697
MANAGED HEALTH SERVICE
WI
Enumeration date
10/07/2005
Last updated
07/08/2007
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