Healthcare Provider Details

I. General information

NPI: 1952743627
Provider Name (Legal Business Name): JOHN DAVID GELLES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FRANK W BURR BLVD STE 71
TEANECK NJ
07666-6703
US

IV. Provider business mailing address

300 FRANK W BURR BLVD STE 71
TEANECK NJ
07666-6703
US

V. Phone/Fax

Practice location:
  • Phone: 201-692-9434
  • Fax: 201-692-9646
Mailing address:
  • Phone: 201-692-9434
  • Fax: 201-692-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00665400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: