MEDICARE: SCOTT L. GELLER MD, 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	207W00000X	Ophthalmology Physician
2	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629240593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT L. GELLER MD, PA

Provider Business Mailing Address
First Line	:	4755 SUMMERLIN RD
Second Line	:	SUITE # 1
City	:	FORT MYERS
State	:	FL
Zip	:	33919-1073
Country	:	US
Telephone Number	:	239-275-8222
Fax Number	:	239-275-9080

Provider Business Practice Location Address
First Line	:	4755 SUMMERLIN RD
Second Line	:	SUITE # 1
City	:	FORT MYERS
State	:	FL
Zip	:	33919-1073
Country	:	US
Telephone Number	:	239-275-8222
Fax Number	:	239-275-9080

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. SCOTT L GELLER
Credential	:	MD
Telephone Number	:	239-275-8222

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	01/31/2012

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