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General NPI Number Information
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NPI Number | 1730377573
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Entity Type | Individual
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Provider Name | STEPHANIE LYNN GELFIUS O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 2121 HUDSON AVE SUITE 105
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City | KALAMAZOO
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State | MI
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Zip | 49008-2379
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Country | US
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Telephone | 269-345-2916
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Fax | 269-345-5335
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Provider Business Mailing Address
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Address Line | 2121 HUDSON AVE SUITE 105
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City | KALAMAZOO
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State | MI
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Zip | 49008-2379
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Country | US
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Telephone | 269-345-2916
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Fax | 269-345-5335
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4901003752
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License Number State | MI
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