Provider Demographics
NPI:1952892879
Name:GAO, JERRY J
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:J
Last Name:GAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ROSS PARK MALL DR # N01H
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3875
Mailing Address - Country:US
Mailing Address - Phone:412-447-8888
Mailing Address - Fax:
Practice Address - Street 1:1000 ROSS PARK MALL DR # N01-H
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3875
Practice Address - Country:US
Practice Address - Phone:304-906-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty