Provider Demographics
NPI:1770615205
Name:CATES, GERALD LEE (OD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LEE
Last Name:CATES
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 1:1863 PIONEER PKWY E
Mailing Address - Street 2:#303
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3907
Mailing Address - Country:US
Mailing Address - Phone:541-741-0122
Mailing Address - Fax:541-988-3401
Practice Address - Street 1:1871 2ND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2121
Practice Address - Country:US
Practice Address - Phone:541-741-0122
Practice Address - Fax:541-988-3401
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1033T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR028795Medicaid
ORU13646Medicare UPIN
OR028795Medicaid