Individual
ERIC JERDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
10275 WATSON RD, SAINT LOUIS, MO 63127
(314) 962-9334
Mailing address
10275 WATSON RD, SAINT LOUIS, MO 63127-1103
(314) 962-9334
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
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