Provider Demographics
NPI:1669606349
Name:MICHAEL RAY GERDTS LTD
Entity type:Organization
Organization Name:MICHAEL RAY GERDTS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GERDTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-466-1700
Mailing Address - Street 1:1508 RESEARCH FOREST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4374
Mailing Address - Country:US
Mailing Address - Phone:281-466-1700
Mailing Address - Fax:281-466-1704
Practice Address - Street 1:1508 RESEARCH FOREST DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77381-4374
Practice Address - Country:US
Practice Address - Phone:281-466-1700
Practice Address - Fax:281-466-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6836T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6836TOtherTEXAS OPTOMETRY LICENSE