Provider Demographics
NPI:1386751519
Name:ALGER, GEMMA (OD)
Entity type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:ALGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SUNDANCE PKWY # 120A
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-7914
Mailing Address - Country:US
Mailing Address - Phone:512-782-4244
Mailing Address - Fax:
Practice Address - Street 1:488 HIGHWAY 71 W
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3731
Practice Address - Country:US
Practice Address - Phone:512-303-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6057T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020FDOtherBCBS PROVIDER NUMBER
TX200140170OtherTAX ID NUMBER