Healthcare Provider Details

I. General information

NPI: 1366629768
Provider Name (Legal Business Name): SHERMAN ANDREW GELLER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 BROAD ST
BRIDGEWATER MA
02324-1748
US

IV. Provider business mailing address

54 BROAD ST
BRIDGEWATER MA
02324-1748
US

V. Phone/Fax

Practice location:
  • Phone: 508-697-8001
  • Fax: 508-697-8001
Mailing address:
  • Phone: 508-697-8001
  • Fax: 508-697-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2663
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: