Individual
DR. GARY JOHN BURKHARDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
19 W MAIN ST, CHILTON, WI 53014-1323
(920) 849-4291
(920) 849-4292
Mailing address
19 W MAIN ST, CHILTON, WI 53014-1323
(920) 849-4291
(920) 849-4292
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1989035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38588600
—
WI
Enumeration date
12/26/2005
Last updated
01/28/2013
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