Provider Demographics
NPI:1164411195
Name:SALDANA, GERARDO JR (OD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:SALDANA
Suffix:JR
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:PO BOX 632600
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-2600
Mailing Address - Country:US
Mailing Address - Phone:936-564-7661
Mailing Address - Fax:936-564-6622
Practice Address - Street 1:3208 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2633
Practice Address - Country:US
Practice Address - Phone:936-564-7661
Practice Address - Fax:936-564-6622
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06253TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154278902Medicaid
TX06253TGOtherTX LICENSE
TXU92271Medicare UPIN
TX8A9242Medicare ID - Type Unspecified