Provider Demographics
NPI:1275698979
Name:GERLAN, MICHAEL VICTOR (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VICTOR
Last Name:GERLAN
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 1:99 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5208
Mailing Address - Country:US
Mailing Address - Phone:914-948-6969
Mailing Address - Fax:914-948-6969
Practice Address - Street 1:99 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5208
Practice Address - Country:US
Practice Address - Phone:914-948-6969
Practice Address - Fax:914-948-6969
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV4578-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01212188Medicaid
NY0153940001Medicare NSC