Healthcare Provider Details

I. General information

NPI: 1487631172
Provider Name (Legal Business Name): JULIA RAE GELDIS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 N STANWOOD RD
BEXLEY OH
43209-1504
US

IV. Provider business mailing address

199 N STANWOOD RD
BEXLEY OH
43209-2330
US

V. Phone/Fax

Practice location:
  • Phone: 614-657-7769
  • Fax:
Mailing address:
  • Phone: 614-657-7769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5539
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: