Provider Demographics
NPI:1801863980
Name:ZELLER, IRENE M (OD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:M
Last Name:ZELLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:M
Other - Last Name:FERENAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8055 MAYFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2447
Mailing Address - Country:US
Mailing Address - Phone:440-214-8026
Mailing Address - Fax:216-201-7963
Practice Address - Street 1:5805 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3715
Practice Address - Country:US
Practice Address - Phone:216-675-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001401152W00000X
OH5305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2337706Medicaid
PA100957589Medicaid
U91504Medicare UPIN
OH2337706Medicaid
PA079017Medicare ID - Type Unspecified