Provider Demographics
NPI:1245504851
Name:GILBERT, MARZENA KELDER (OD)
Entity type:Individual
Prefix:DR
First Name:MARZENA
Middle Name:KELDER
Last Name:GILBERT
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 1:1280 S VICTORIA AVE
Mailing Address - Street 2:#100
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6555
Mailing Address - Country:US
Mailing Address - Phone:805-650-9922
Mailing Address - Fax:
Practice Address - Street 1:1280 S VICTORIA AVE
Practice Address - Street 2:#100
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6555
Practice Address - Country:US
Practice Address - Phone:805-650-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist