Provider Demographics
NPI:1710926449
Name:GERDES, ROBERT J
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:GERDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1653
Mailing Address - Country:US
Mailing Address - Phone:330-534-2421
Mailing Address - Fax:330-534-1960
Practice Address - Street 1:30 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1653
Practice Address - Country:US
Practice Address - Phone:330-534-2421
Practice Address - Fax:330-534-1960
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3735 T451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0574187Medicaid
OH0563651Medicare PIN
OHGE0563651Medicare ID - Type Unspecified
OH0574187Medicaid
OH0593330001Medicare NSC