Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1339527T | LA |
NPI | 1013056308 |
---|---|
Provider Name | Dr. Gerald George Gerdes JR. |
First Address | Oakdale, LA 71463-2624 |
Second Address | Oakdale, LA 71463-2624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 25/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1464619 | (05) | LA |
V01246 | (02) | LA |