Provider Demographics
NPI:1528071651
Name:HILDEBRAND, GERARD J (OD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:J
Last Name:HILDEBRAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:304 W TIOGA ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657
Practice Address - Country:US
Practice Address - Phone:570-836-2224
Practice Address - Fax:570-836-1125
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
506554OtherAETNA
PA001622963Medicaid
081368OtherFIRST PRIORITY HEALTH
15517OtherGEISINGER
H1024926OtherHIGH MARK BLUE SHIELD
410032233OtherRAILROAD MEDICARE
410032233OtherRAILROAD MEDICARE
PAHI024926Medicare ID - Type Unspecified