Provider Demographics
NPI:1215013305
Name:GERSON, PHILIP (OD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:GERSON
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 1:7252 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1017
Mailing Address - Country:US
Mailing Address - Phone:215-335-3555
Mailing Address - Fax:215-335-3540
Practice Address - Street 1:7252 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1017
Practice Address - Country:US
Practice Address - Phone:215-335-3555
Practice Address - Fax:215-335-3540
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE004177T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100737324003Medicaid
PA281125Medicare PIN
PAU07746Medicare UPIN
PA0148380001Medicare NSC