Healthcare Provider Details

I. General information

NPI: 1568524213
Provider Name (Legal Business Name): ZUZANA ROOS GELLNER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2369 HARRISON AVE
EUREKA CA
95501-3216
US

IV. Provider business mailing address

2369 HARRISON AVE
EUREKA CA
95501-3216
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-1472
  • Fax: 707-442-2723
Mailing address:
  • Phone: 707-442-1472
  • Fax: 707-442-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9561 TPL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: