Basic Information
| Provider Information | |||||||||
| NPI: | 1730467549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEBHARDT | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | BOMKAMP | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193562852 | ||||||||
| FaxNumber: | 3193561520 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193562852 | ||||||||
| FaxNumber: | 3193561520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2011 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18003923A | IN | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 046.010437 | IL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 5199 | MA | N | Eye and Vision Services Providers | Optometrist | 152WC0802X | 113033 | IA | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152W00000X | 113033 | IA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.