Provider Demographics
NPI:1841370012
Name:NEIDIGH, GERALD R JR (OD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:R
Last Name:NEIDIGH
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3601 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2201
Mailing Address - Country:US
Mailing Address - Phone:804-358-8443
Mailing Address - Fax:804-358-1395
Practice Address - Street 1:3601 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2201
Practice Address - Country:US
Practice Address - Phone:804-358-8443
Practice Address - Fax:804-358-1395
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA410001073Medicare ID - Type Unspecified
VAU71700Medicare UPIN
VA410038526Medicare ID - Type UnspecifiedRAILROAD MEDICARE