Provider Demographics
NPI:1922067701
Name:GERIG, WAYNE L (OD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:L
Last Name:GERIG
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 1:10225 SW HALL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8855
Mailing Address - Country:US
Mailing Address - Phone:503-244-1004
Mailing Address - Fax:503-244-1006
Practice Address - Street 1:10225 SW HALL BLVD
Practice Address - Street 2:SUITE101
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8855
Practice Address - Country:US
Practice Address - Phone:503-244-1004
Practice Address - Fax:503-244-1006
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1478AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR283135Medicaid
OR1922067701Medicare NSC
ORR105252Medicare PIN
ORT67641Medicare UPIN