Provider Demographics
NPI:1598884884
Name:GERICKE, ERIC D (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:GERICKE
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 1:1518 E BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3704
Mailing Address - Country:US
Mailing Address - Phone:417-881-5530
Mailing Address - Fax:417-889-4071
Practice Address - Street 1:1518 E BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3704
Practice Address - Country:US
Practice Address - Phone:417-881-5530
Practice Address - Fax:417-889-4071
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU05667Medicare UPIN