Provider Demographics
NPI:1700823093
Name:GELLNER, CINDY LOU (OD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LOU
Last Name:GELLNER
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 1:2000 23RD ST S
Mailing Address - Street 2:CENTRACARE SAUK CROSSING
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4765
Mailing Address - Country:US
Mailing Address - Phone:320-253-3637
Mailing Address - Fax:320-253-5412
Practice Address - Street 1:2000 23RD ST S
Practice Address - Street 2:CENTRACARE SAUK CROSSING
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4765
Practice Address - Country:US
Practice Address - Phone:320-253-3637
Practice Address - Fax:320-253-5412
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2033152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T65535Medicare UPIN