Healthcare Provider Details

I. General information

NPI: 1992801591
Provider Name (Legal Business Name): MILTON GERTNER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 GUILFORD DR
FREDERICK MD
21704-5100
US

IV. Provider business mailing address

7400 GUILFORD DR
FREDERICK MD
21704-5100
US

V. Phone/Fax

Practice location:
  • Phone: 301-631-2274
  • Fax: 301-682-5437
Mailing address:
  • Phone: 301-631-2274
  • Fax: 301-682-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA970
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: