Provider Demographics
NPI:1699097337
Name:ROBERT GEHRKE OD
Entity type:Organization
Organization Name:ROBERT GEHRKE OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ROYER
Authorized Official - Last Name:GEHRKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-965-0234
Mailing Address - Street 1:10624 JACOB DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9474
Mailing Address - Country:US
Mailing Address - Phone:708-479-4502
Mailing Address - Fax:
Practice Address - Street 1:7050 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD PARK
Practice Address - State:IL
Practice Address - Zip Code:60638-6402
Practice Address - Country:US
Practice Address - Phone:708-496-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009461152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009461Medicaid