Provider Demographics
NPI:1861643702
Name:STAFFORD, GERARD H (OD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:H
Last Name:STAFFORD
Suffix:
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 1:2391 S WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3910
Mailing Address - Country:US
Mailing Address - Phone:713-714-6533
Mailing Address - Fax:832-831-6851
Practice Address - Street 1:2391 S WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3910
Practice Address - Country:US
Practice Address - Phone:713-714-6533
Practice Address - Fax:832-831-6851
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7273T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7273TOtherTEXAS OPTOMETRY LICENSE