Provider Demographics
NPI:1679572440
Name:GESS, JOHN A (OD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:GESS
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 1:109 15TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2509
Mailing Address - Country:US
Mailing Address - Phone:320-762-5112
Mailing Address - Fax:320-763-3297
Practice Address - Street 1:109 15TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2512
Practice Address - Country:US
Practice Address - Phone:320-762-5112
Practice Address - Fax:320-763-3297
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP34132/80031OtherHEALTHPARTNERS
MN48G31GEOtherBLUE CROSS/BLUE SHIELD
MNT65538OtherHUMANA
MN030701146Medicaid
MNT65538OtherUNICARE
MN22-00883OtherMEDICA
MN077023000Medicaid
MN22-00883OtherMEDICA
MNT65538OtherUNICARE
MN410001681Medicare PIN
MN410049329Medicare PIN