Provider Demographics
NPI:1609838929
Name:PEARCH, GARY B (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:PEARCH
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 1:131 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-1213
Mailing Address - Country:US
Mailing Address - Phone:740-942-3413
Mailing Address - Fax:740-942-3413
Practice Address - Street 1:131 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-1213
Practice Address - Country:US
Practice Address - Phone:740-942-3413
Practice Address - Fax:740-942-3413
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0272011Medicaid
OH0439450001Medicare NSC
OH0272011Medicaid
OHT46914Medicare UPIN
OHPE0441972Medicare ID - Type Unspecified