Provider Demographics
NPI:1841545290
Name:ROBERT GERSON O.D.
Entity type:Organization
Organization Name:ROBERT GERSON O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-771-8321
Mailing Address - Street 1:3737 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-5242
Mailing Address - Country:US
Mailing Address - Phone:904-771-8321
Mailing Address - Fax:904-771-3389
Practice Address - Street 1:3737 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-5242
Practice Address - Country:US
Practice Address - Phone:904-771-8321
Practice Address - Fax:904-771-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084336900Medicaid
FLT93826Medicare UPIN
FL084336900Medicaid