Provider Demographics
NPI:1790755627
Name:GEIST, GERALD DAVID JR (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DAVID
Last Name:GEIST
Suffix:JR
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 1:980 N SUSQUEHANNA TRL
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-7766
Mailing Address - Country:US
Mailing Address - Phone:570-743-9000
Mailing Address - Fax:570-743-9001
Practice Address - Street 1:980 N SUSQUEHANNA TRL
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-7766
Practice Address - Country:US
Practice Address - Phone:570-743-9000
Practice Address - Fax:570-743-9001
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000715152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015151030001Medicaid
PA560994Medicare PIN
PA0015151030001Medicaid