Provider Demographics
NPI:1083972731
Name:GERALD A MAYER OD PA
Entity Type:Organization
Organization Name:GERALD A MAYER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-578-9599
Mailing Address - Street 1:7187 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1050
Mailing Address - Country:US
Mailing Address - Phone:954-476-9654
Mailing Address - Fax:
Practice Address - Street 1:7187 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1050
Practice Address - Country:US
Practice Address - Phone:954-578-9599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0844837Medicaid
FL19213Medicare PIN
FL0844837Medicaid