Provider Demographics
NPI:1952820045
Name:GERARD EYE CO. ,PA
Entity Type:Organization
Organization Name:GERARD EYE CO. ,PA
Other - Org Name:GERARD EYE CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-240-2643
Mailing Address - Street 1:12455 RIDGEDALE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1787
Mailing Address - Country:US
Mailing Address - Phone:952-545-6010
Mailing Address - Fax:952-252-0999
Practice Address - Street 1:12455 RIDGEDALE DR STE 101
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1787
Practice Address - Country:US
Practice Address - Phone:952-545-6010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN973157100Medicaid