Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 14658 | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 14658 | CA |
N | 152WP0200X | Pediatric Optomitrist | 14658 | CA |
N | 152WV0400X | Optomitrist - Vision Therapist | 14658 | CA |
N | 152WX0102X | Occupational Vision | 14658 | CA |
NPI | 1033558069 |
---|---|
Provider Name | Matthew Geller |
First Address | Spring Valley, CA 91977-1245 |
Second Address | Spring Valley, CA 91977-1245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 12/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14658 | CALIFORNIA STATE BOARD OF OPTOMETRY (01) | CA |
TUV007984-1 | NEW YORK STATE BOARD OF OPTOMETRY (01) | NY |