Healthcare Provider Details

I. General information

NPI: 1235122136
Provider Name (Legal Business Name): BARRY L GELLIS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 24TH ST STE 401
ERIE PA
16502-2665
US

IV. Provider business mailing address

311 W 24TH ST STE 401
ERIE PA
16502-2665
US

V. Phone/Fax

Practice location:
  • Phone: 814-455-7591
  • Fax: 814-454-1467
Mailing address:
  • Phone: 814-455-7591
  • Fax: 814-454-1467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001073
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: