Provider Demographics
NPI:1609858711
Name:GELLER, SCOTT L (MD,PA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:L
Last Name:GELLER
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 SUMMERLIN RD
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1073
Mailing Address - Country:US
Mailing Address - Phone:239-275-8222
Mailing Address - Fax:239-275-9080
Practice Address - Street 1:4755 SUMMERLIN RD
Practice Address - Street 2:SUITE # 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1073
Practice Address - Country:US
Practice Address - Phone:239-275-8222
Practice Address - Fax:239-275-9080
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36315OtherBCBS
FL623816OtherAETNA
FL1114036OtherCIGNA
FL066192900Medicaid
FL623816OtherAETNA
FL066192900Medicaid