MEDICARE: JUDITH A ZELLERS OD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC1708	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPC1708	OTHER	FL	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528128667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDITH A ZELLERS OD PA

Provider Business Mailing Address
First Line	:	3925 BONITA BEACH RD
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4112
Country	:	US
Telephone Number	:	239-947-6000
Fax Number	:	239-947-3914

Provider Business Practice Location Address
First Line	:	3925 BONITA BEACH RD
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4112
Country	:	US
Telephone Number	:	239-947-6000
Fax Number	:	239-947-3914

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUDITH ANN ZELLERS
Credential	:	O.D.
Telephone Number	:	239-947-6000

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	05/12/2008

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Directions to “JUDITH A ZELLERS OD PA ” Practice Location

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