Individual
ERIC JERDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2012018551
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609121839
—
MO
05
—
193954722
—
AR
01
—
431560263
TRICARE
MO
01
—
P01235247
RR MCR
MO
Enumeration date
07/13/2012
Last updated
07/23/2018
Update your record
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