Provider Demographics
NPI:1982711610
Name:GERDES, HERMAN H III (OD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:H
Last Name:GERDES
Suffix:III
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 1:4949 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-6900
Mailing Address - Country:US
Mailing Address - Phone:254-776-2282
Mailing Address - Fax:
Practice Address - Street 1:4949 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-6900
Practice Address - Country:US
Practice Address - Phone:254-776-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2467TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80623QOtherBLUE CROSS BLUE SHEILD
TX410045433OtherPALMETTO GBA RAILROAD MEDICARE
TX019234601Medicaid
TX113466100OtherFIRST CARE
TX0913600001Medicare NSC
TXT13430Medicare UPIN
TX019234601Medicaid