Healthcare Provider Details

I. General information

NPI: 1639136450
Provider Name (Legal Business Name): GERALD ALAN OGDEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402 BOX 335
APO AE
09180
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402 BOX 335
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 011496371868288
  • Fax: 011496371866193
Mailing address:
  • Phone: 011496371868288
  • Fax: 011496371866193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number03281T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: