Provider Demographics
NPI:1366629768
Name:GELLER, SHERMAN ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERMAN
Middle Name:ANDREW
Last Name:GELLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1748
Mailing Address - Country:US
Mailing Address - Phone:508-697-8001
Mailing Address - Fax:508-697-8001
Practice Address - Street 1:54 BROAD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1748
Practice Address - Country:US
Practice Address - Phone:508-697-8001
Practice Address - Fax:508-697-8001
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2663152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0333808Medicaid
MA0333808Medicaid
MA194858Medicare PIN