Provider Demographics
NPI:1497707244
Name:GERDES, GREGORY P (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:GERDES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:836 S 130TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2914
Mailing Address - Country:US
Mailing Address - Phone:402-330-0616
Mailing Address - Fax:402-391-3335
Practice Address - Street 1:3020 S 84TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3215
Practice Address - Country:US
Practice Address - Phone:402-391-1143
Practice Address - Fax:402-391-3335
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENEBRASKA 985 TPA 162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE41-098-5054-18Medicaid
NE41-098-5054-18Medicaid
NEU12176Medicare UPIN