Provider Demographics
NPI:1396794053
Name:GELNER, PATRICIA V (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:V
Last Name:GELNER
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 1:14386 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5714
Mailing Address - Country:US
Mailing Address - Phone:314-434-2626
Mailing Address - Fax:314-434-2631
Practice Address - Street 1:14386 WOODLAKE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5714
Practice Address - Country:US
Practice Address - Phone:314-434-2626
Practice Address - Fax:314-434-2631
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOT02393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32331OtherBLUE CROSS
MOGE312309800Medicaid
MO07144OtherSPECTERA
MO325596OtherHEALTHLINK
MOMO2393OtherEYEMED
MO07144OtherSPECTERA
MOGE312309800Medicaid
MO0313650001Medicare ID - Type UnspecifiedCIGNA DURABLE GOODS