Provider Demographics
NPI:1215265749
Name:DR. DOUGLAS E GERZINA INC
Entity type:Organization
Organization Name:DR. DOUGLAS E GERZINA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GERZINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-545-3016
Mailing Address - Street 1:290 BECKETT RD
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-3044
Mailing Address - Country:US
Mailing Address - Phone:724-545-3016
Mailing Address - Fax:
Practice Address - Street 1:961 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-9163
Practice Address - Country:US
Practice Address - Phone:814-663-8750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008812152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty