Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3513 | MN |
N | 152WP0200X | Pediatric Optomitrist | 3513 | MN |
N | 152WS0006X | Sports Vision | 3513 | MN |
N | 152WV0400X | Optomitrist - Vision Therapist | 3513 | MN |
NPI | 1003338211 |
---|---|
Provider Name | Dr. Kelsey Marie Manescalco |
First Address | Otsego, MN 55330-7448 |
Second Address | Otsego, MN 55330-7448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2017 |
Last Update Date | 10/07/2017 |