Individual
DR. LARRY F JERGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1151 STONECREST BLVD., FORT MILL, SC 29708
(803) 802-4733
(803) 802-4735
Mailing address
600 PINE LINKS DR, TEGA CAY, SC 29708-7205
(803) 325-4298
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1468
SC
152W00000X
Optometrist
UT-003877-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D14688
—
SC
Enumeration date
07/26/2005
Last updated
03/04/2008
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