Provider Demographics
NPI:1780099697
Name:GERARD, JONATHAN (OD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:GERARD
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 1:4 BRIDGEPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:LAURENCE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2908
Mailing Address - Country:US
Mailing Address - Phone:518-542-3228
Mailing Address - Fax:
Practice Address - Street 1:530 LAKEHURST RD
Practice Address - Street 2:SUITE 206
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8063
Practice Address - Country:US
Practice Address - Phone:732-341-4733
Practice Address - Fax:732-341-2794
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00653200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist