Provider Demographics
NPI:1861583981
Name:CONTNER, GARY E (OD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:E
Last Name:CONTNER
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 1:1008 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2371
Mailing Address - Country:US
Mailing Address - Phone:937-599-5315
Mailing Address - Fax:937-599-1185
Practice Address - Street 1:1008 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2371
Practice Address - Country:US
Practice Address - Phone:937-599-5315
Practice Address - Fax:937-599-1185
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3526152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0566105Medicaid
OHC9354411OtherMEDICARE PTAN
OH300285181028Medicaid
OH300285181028Medicaid
P00221595Medicare PIN
OHCO0505491Medicare PIN
OHT47428Medicare UPIN
5990490001Medicare NSC