Individual
DR. GERRIT H. DEVRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
609 N HALLECK ST, DEMOTTE, IN 46310-9545
(219) 987-3673
(219) 987-3905
Mailing address
PO BOX 849, DEMOTTE, IN 46310-0849
(219) 987-3673
(219) 987-3905
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001809B
IN
152WC0802X
Corneal and Contact Management Optometrist
18001809B
IN
152WP0200X
Pediatric Optometrist
18001809B
IN
152WX0102X
Occupational Vision Optometrist
18001809B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100142770A
—
IN
Enumeration date
07/27/2006
Last updated
09/02/2010
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