Provider Demographics
NPI:1306912217
Name:ZELLERS, JUDITH ANN (OD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:ZELLERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3925 BONITA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4112
Mailing Address - Country:US
Mailing Address - Phone:239-947-6000
Mailing Address - Fax:239-947-3914
Practice Address - Street 1:3925 BONITA BEACH RD
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4112
Practice Address - Country:US
Practice Address - Phone:239-947-6000
Practice Address - Fax:239-947-3914
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC1708OtherLICENSE NUMBER
FLOPC1708OtherLICENSE NUMBER
FLT85233Medicare UPIN