Provider Demographics
NPI:1821366204
Name:GARY P GEGERSON, O.D.,P.A.
Entity Type:Organization
Organization Name:GARY P GEGERSON, O.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GEGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD,
Authorized Official - Phone:305-256-2525
Mailing Address - Street 1:12139 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5200
Mailing Address - Country:US
Mailing Address - Phone:305-256-2525
Mailing Address - Fax:305-252-7770
Practice Address - Street 1:12139 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-5200
Practice Address - Country:US
Practice Address - Phone:305-256-2525
Practice Address - Fax:305-252-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty