Healthcare Provider Details

I. General information

NPI: 1609858711
Provider Name (Legal Business Name): SCOTT L GELLER M.D.,P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 SUMMERLIN RD SUITE # 1
FORT MYERS FL
33919-1073
US

IV. Provider business mailing address

4755 SUMMERLIN RD SUITE # 1
FORT MYERS FL
33919-1073
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-8222
  • Fax: 239-275-9080
Mailing address:
  • Phone: 239-275-8222
  • Fax: 239-275-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0035800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: