Provider Demographics
NPI:1679534705
Name:ZELL, GREGORY GENE (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GENE
Last Name:ZELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:G
Other - Last Name:ZELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 4071
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-4071
Mailing Address - Country:US
Mailing Address - Phone:406-721-4646
Mailing Address - Fax:406-721-3859
Practice Address - Street 1:2510 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7546
Practice Address - Country:US
Practice Address - Phone:406-721-4646
Practice Address - Fax:406-721-3859
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOPT-LIC-474152WC0802X
WA1460152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT48-3743Medicaid
MT48-3743Medicaid