Provider Demographics
NPI:1003367145
Name:GEROW, MELDA NIL (OD)
Entity Type:Individual
Prefix:DR
First Name:MELDA
Middle Name:NIL
Last Name:GEROW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2920
Mailing Address - Country:US
Mailing Address - Phone:617-213-2131
Mailing Address - Fax:617-213-2001
Practice Address - Street 1:42 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2920
Practice Address - Country:US
Practice Address - Phone:617-213-2131
Practice Address - Fax:617-213-2001
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2023-11-03
Deactivation Date:2022-07-19
Deactivation Code:
Reactivation Date:2022-08-11
Provider Licenses
StateLicense IDTaxonomies
MA5186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist