Individual
DR. MAURICE WILLIAM GELDERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
200 W WILSHIRE BLVD, SUITE D, ROSWELL, NM 88201-0627
(575) 623-5111
(575) 623-9639
Mailing address
200 W WILSHIRE BLVD, SUITE D, ROSWELL, NM 88201-0627
(575) 623-5111
(575) 623-9639
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
383
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0678960001
DMERC REGION C
NM
01
—
201003466
PRESBYTERIAN HEALTH PLAN
NM
01
—
436603246
MEDICARE PTAN
NM
05
—
P1483
—
NM
01
—
P315
BLUE CROSS BLUE SHIELD NM
NM
Enumeration date
09/23/2005
Last updated
06/16/2009
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