Healthcare Provider Details

I. General information

NPI: 1396794053
Provider Name (Legal Business Name): PATRICIA V GELNER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14386 WOODLAKE DR
CHESTERFIELD MO
63017-5714
US

IV. Provider business mailing address

14386 WOODLAKE DR
CHESTERFIELD MO
63017-5714
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-2626
  • Fax: 314-434-2631
Mailing address:
  • Phone: 314-434-2626
  • Fax: 314-434-2631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMOT02393
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: