Provider Demographics
NPI:1841446044
Name:GERGES, MARY (OD)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:
Last Name:GERGES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:265 LEHIGH VALLEY MALL
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-5719
Mailing Address - Country:US
Mailing Address - Phone:610-266-6666
Mailing Address - Fax:610-266-2984
Practice Address - Street 1:265 LEHIGH VALLEY MALL
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-5719
Practice Address - Country:US
Practice Address - Phone:610-266-6666
Practice Address - Fax:610-266-2984
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002118152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist