Provider Demographics
NPI:1588849988
Name:HERMAN H GERDES III
Entity Type:Organization
Organization Name:HERMAN H GERDES III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GERDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-776-3423
Mailing Address - Street 1:4949 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-6917
Mailing Address - Country:US
Mailing Address - Phone:254-776-3423
Mailing Address - Fax:254-776-3465
Practice Address - Street 1:4949 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-6900
Practice Address - Country:US
Practice Address - Phone:254-776-3423
Practice Address - Fax:254-776-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2467TG332B00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
80623QOtherBLUE CROSS
TX0054FAOtherBLUE CROSS
TX0913600001Medicare NSC
T13430Medicare UPIN
00E16EMedicare PIN