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General NPI Number Information
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NPI Number | 1760042410
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Entity Type | Individual
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Provider Name | ELLEN NICOLE GEISEN OD
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Gender | Female
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Dates
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Enumeration Date | 06/15/2019
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 11595 N MERIDIAN ST STE 175
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City | CARMEL
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State | IN
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Zip | 46032-4408
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Country | US
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Telephone | 317-942-7255
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Fax |
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Provider Business Mailing Address
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Address Line | 6111 N MERIDIAN ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-1535
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Country | US
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Telephone | 219-306-5602
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Fax |
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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 | 18004165A
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License Number State | IN
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