Provider Demographics
NPI:1255388294
Name:GERO, GEORGE (OD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:GERO
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 1:111 E CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0412
Mailing Address - Country:US
Mailing Address - Phone:701-222-1420
Mailing Address - Fax:701-255-2414
Practice Address - Street 1:111 E CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0412
Practice Address - Country:US
Practice Address - Phone:701-222-1420
Practice Address - Fax:701-255-2414
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60388Medicaid
D001533OtherCHAMPUS TRICA RE
12147OtherELGIN BCBS MEDICARE
800367OtherND VISION BCBS
8883OtherBCBS MEDICARE
60388OtherND SOCIAL SERVICE
60388OtherND SOCIAL SERVICE
NDMG0331897Medicare PIN
ND8883Medicare PIN
12147OtherELGIN BCBS MEDICARE
ND410016508Medicare PIN