Organization
JOANNA M GERVAIS OD LLC
Active
Other names
Custom Eyes
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOANNA M GERVAIS OD (OPTOMETRIST/OWNER)
(541) 777-0245
Entity
Organization
Contact information
Practice address
1871 2ND ST, SPRINGFIELD, OR 97477-2121
(541) 741-0122
Mailing address
1871 2ND ST, SPRINGFIELD, OR 97477-2121
(541) 741-0122
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3263AT
OR
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
10/19/2009
Last updated
11/16/2009
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