Healthcare Provider Details

I. General information

NPI: 1821146697
Provider Name (Legal Business Name): KELLY L GELARDEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6985 W 38TH ST STE 100
INDIANAPOLIS IN
46254-3918
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 317-243-0028
  • Fax:
Mailing address:
  • Phone: 703-847-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002226A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: