Provider Demographics
NPI:1083616676
Name:GERBERRY, ROBERT J (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:GERBERRY
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 1:10 DUTTON DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-1818
Mailing Address - Country:US
Mailing Address - Phone:330-746-7691
Mailing Address - Fax:330-743-8368
Practice Address - Street 1:10 DUTTON DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1818
Practice Address - Country:US
Practice Address - Phone:330-746-7691
Practice Address - Fax:330-743-8368
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2943 T333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000126324OtherANTHEM
OH0145435Medicaid
OH4387948OtherAETNA
OH2200182OtherUNITED HEALTHCARE
OH000099146OtherKEYSTONE
OH180011156OtherRAILROAD MEDICARE
OH341038973AOtherSUMMACARE
OH0145435Medicaid
OH2200182OtherUNITED HEALTHCARE