Healthcare Provider Details

I. General information

NPI: 1801863980
Provider Name (Legal Business Name): IRENE M. ZELLER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE M FERENAC O.D.

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 EUCLID AVE
CLEVELAND OH
44103-3715
US

IV. Provider business mailing address

8055 MAYFIELD RD STE 105
CHESTERLAND OH
44026-2447
US

V. Phone/Fax

Practice location:
  • Phone: 216-675-6630
  • Fax:
Mailing address:
  • Phone: 440-214-8026
  • Fax: 216-201-7963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001401
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5305
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: