Provider Demographics
NPI:1851340889
Name:GERLOCK, RHEDA SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:RHEDA
Middle Name:SUE
Last Name:GERLOCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:155
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-369-1020
Practice Address - Fax:303-369-1022
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1215152W00000X
COOPT.0001215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MG0015479OtherDEA
MG0015479OtherDEA
T60859Medicare UPIN