Provider Demographics
NPI:1235122136
Name:GELLIS, BARRY L (OD)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:L
Last Name:GELLIS
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 1:311 W 24TH ST
Mailing Address - Street 2:STE 401
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2665
Mailing Address - Country:US
Mailing Address - Phone:814-455-7591
Mailing Address - Fax:814-454-1467
Practice Address - Street 1:311 W 24TH ST
Practice Address - Street 2:STE 401
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2665
Practice Address - Country:US
Practice Address - Phone:814-455-7591
Practice Address - Fax:814-454-1467
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001073152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005620100004Medicaid
0739350001OtherDMERC
GE60796OtherBS
P00178464OtherGBA RR
PAOEG001073OtherPA NUMBER
PAOEG001073OtherPA NUMBER
T72499Medicare UPIN
PA060796Medicare ID - Type Unspecified