Provider Demographics
NPI:1184658270
Name:MAYER, GERALD ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ALLEN
Last Name:MAYER
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 1:7187 W OAKLAND PK 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:954-578-9599
Mailing Address - Fax:954-578-9464
Practice Address - Street 1:7187 W OAKLAND PK 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:954-578-9464
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 001102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084483700Medicaid
T93833Medicare UPIN
19213Medicare ID - Type Unspecified