Provider Demographics
NPI:1841356532
Name:GERARD, ARA C (OD)
Entity type:Individual
Prefix:DR
First Name:ARA
Middle Name:C
Last Name:GERARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ARA
Other - Middle Name:C
Other - Last Name:SUDTELGTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
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:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN973157100Medicaid
MNU97730Medicare UPIN
MN410002060Medicare PIN