Provider Demographics
NPI:1265871933
Name:GENDELMAN, NELLYA (OD)
Entity type:Individual
Prefix:DR
First Name:NELLYA
Middle Name:
Last Name:GENDELMAN
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 1:1301 W GLADE RD
Mailing Address - Street 2:STE 196
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-5418
Mailing Address - Country:US
Mailing Address - Phone:817-685-7011
Mailing Address - Fax:817-685-7211
Practice Address - Street 1:1301 W GLADE RD
Practice Address - Street 2:STE 196
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-5418
Practice Address - Country:US
Practice Address - Phone:817-685-7011
Practice Address - Fax:817-685-7211
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8198T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist