Provider Demographics
NPI:1093793903
Name:GERHARDT, TOD S (OD)
Entity Type:Individual
Prefix:
First Name:TOD
Middle Name:S
Last Name:GERHARDT
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 1:2743 MT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2137
Mailing Address - Country:US
Mailing Address - Phone:319-754-2020
Mailing Address - Fax:319-754-2299
Practice Address - Street 1:2743 MT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-2137
Practice Address - Country:US
Practice Address - Phone:319-754-2020
Practice Address - Fax:319-754-2299
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00286320OtherRAILROAD MEDICARE
IA0467795Medicaid
V06477Medicare UPIN
IA0467795Medicaid