Provider Demographics
NPI:1386718807
Name:GUTSHALL, CARL SCOTT (OD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:SCOTT
Last Name:GUTSHALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-0378
Mailing Address - Country:US
Mailing Address - Phone:402-336-2505
Mailing Address - Fax:402-336-3506
Practice Address - Street 1:214 N 10TH ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1604
Practice Address - Country:US
Practice Address - Phone:402-336-2505
Practice Address - Fax:402-336-3506
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE987152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076692800Medicaid
NE13808OtherMIDLANDS CHOICE
NE47076692800Medicaid
37055OtherBCBS
NE13808OtherMIDLANDS CHOICE
NE47076692800Medicaid