NPIMap

Organization Active NPI

Maurice W. Geldert OD PA

  • Optometrist
  • Roswell, NM
National Provider Identifier
1225276934
Registry record updated Mar 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
383 Issued in NM
Legal business name
MAURICE W. GELDERT OD PA
Practice address
200 W Wilshire Blvd
Suite D
Roswell, NM 88201-0627
Phone
(575) 623-5111
Fax
(575) 623-9639
NPI assigned
Feb 3, 2009
Last updated
Mar 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Maurice W Geldert, O.D.NPI 1861488983
Title
President
Phone
(575) 623-5111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 383 NM Primary

Addresses

Primary practice location

200 W Wilshire Blvd
Suite D
Roswell, NM 88201-0627

Mailing address

200 W Wilshire Blvd
Suite D
Roswell, NM 88201-0627
Phone (575) 623-5111

Other identifiers 1

IdentifierTypeStateIssuer
P1483MedicaidNM

National Provider Directory

National Provider Directory

Locations

200 W Wilshire Blvd
Ste D
Roswell, NM 88201
Phone (575) 623-5111

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269907200000",
    "number": "1225276934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W WILSHIRE BLVD",
            "address_2": "SUITE D",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882010627",
            "telephone_number": "575-623-5111",
            "fax_number": "575-623-9639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W WILSHIRE BLVD",
            "address_2": "SUITE D",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882010627",
            "telephone_number": "575-623-5111",
            "fax_number": "575-623-9639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAURICE W. GELDERT OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-03",
        "last_updated": "2010-03-30",
        "status": "A",
        "authorized_official_last_name": "GELDERT",
        "authorized_official_first_name": "MAURICE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "575-623-5111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NM",
            "license": "383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P1483",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.