Healthcare Provider Details

I. General information

NPI: 1477961985
Provider Name (Legal Business Name): CHERYL A. GELLER RDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 POST RD BENNY'S PLAZA SUITE111
EAST GREENWICH RI
02818-3400
US

IV. Provider business mailing address

5600 POST RD BENNY'S PLAZA SUITE111
EAST GREENWICH RI
02818-3400
US

V. Phone/Fax

Practice location:
  • Phone: 401-885-2166
  • Fax: 401-885-2201
Mailing address:
  • Phone: 401-885-2166
  • Fax: 401-885-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number226
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: