Provider Demographics
NPI:1144262536
Name:GOSNELL, GERALD ROBERT (OD)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ROBERT
Last Name:GOSNELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4631 WYANDOTTE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1542
Mailing Address - Country:US
Mailing Address - Phone:816-931-3937
Mailing Address - Fax:816-931-8584
Practice Address - Street 1:4631 WYANDOTTE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1542
Practice Address - Country:US
Practice Address - Phone:816-931-3937
Practice Address - Fax:816-931-8584
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02862152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA361897Medicare UPIN