Provider Demographics
NPI:1700985173
Name:JANNELLI, GILBERT GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:GEORGE
Last Name:JANNELLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SO FORT HARRISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3903
Mailing Address - Country:US
Mailing Address - Phone:727-461-2020
Mailing Address - Fax:727-442-3937
Practice Address - Street 1:909 SO FORT HARRISON AVENUE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3903
Practice Address - Country:US
Practice Address - Phone:727-461-2020
Practice Address - Fax:727-442-3937
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP1034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084986300Medicaid
FL0478160001Medicare NSC
FL19653Medicare PIN
T84010Medicare UPIN