Provider Demographics
NPI:1790810133
Name:GEIGER, EDWARD MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MICHAEL
Last Name:GEIGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:E
Other - Middle Name:MICHAEL
Other - Last Name:GEIGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:399 E 149 ST
Mailing Address - Street 2:OPTICAL CITY EXPRESS
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455
Mailing Address - Country:US
Mailing Address - Phone:718-292-9500
Mailing Address - Fax:
Practice Address - Street 1:2857 3RD AVE
Practice Address - Street 2:OPTICAL 15100
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:718-585-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT002644152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00342916Medicaid