Provider Demographics
NPI:1689785933
Name:GRELLER, GOLDIE LISA (OD)
Entity Type:Individual
Prefix:
First Name:GOLDIE
Middle Name:LISA
Last Name:GRELLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3069
Mailing Address - Country:US
Mailing Address - Phone:732-577-5558
Mailing Address - Fax:732-577-5559
Practice Address - Street 1:495 IRON BRIDGE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3069
Practice Address - Country:US
Practice Address - Phone:732-577-5558
Practice Address - Fax:732-577-5559
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00559400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist