Provider Demographics
NPI:1760042410
Name:GEISEN, ELLEN NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:NICOLE
Last Name:GEISEN
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 1:6111 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-1535
Mailing Address - Country:US
Mailing Address - Phone:219-306-5602
Mailing Address - Fax:
Practice Address - Street 1:11595 N MERIDIAN ST STE 175
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4408
Practice Address - Country:US
Practice Address - Phone:317-942-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004165A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist