Provider Demographics
NPI:1629118351
Name:APPOLD, JERRY C (OD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:C
Last Name:APPOLD
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 1:2165 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6343
Mailing Address - Country:US
Mailing Address - Phone:989-225-1965
Mailing Address - Fax:989-791-1918
Practice Address - Street 1:4900 FASHION SQUARE BLVD
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2610
Practice Address - Country:US
Practice Address - Phone:989-799-1184
Practice Address - Fax:989-791-1918
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
EMMI3161OtherEYEMED
OH27870Medicare PIN
MIU50776Medicare UPIN