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General NPI Number Information
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NPI Number | 1225276934
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Entity Type | Organization
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Legal Business Name | MAURICE W. GELDERT OD PA
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 200 W WILSHIRE BLVD SUITE D
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City | ROSWELL
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State | NM
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Zip | 88201-0627
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Country | US
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Telephone | 575-623-5111
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Fax | 575-623-9639
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Provider Business Mailing Address
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Address Line | 200 W WILSHIRE BLVD SUITE D
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City | ROSWELL
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State | NM
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Zip | 88201-0627
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Country | US
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Telephone | 575-623-5111
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Fax | 575-623-9639
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAURICE W GELDERT
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Credential | O.D.
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Telephone | 575-623-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 383
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License Number State | NM
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