Provider Demographics
NPI:1992818694
Name:GEHRKE, ROBERT R (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:GEHRKE
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 1:10624 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:708-496-0716
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist