Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | ODP-100146 | ID |
NPI | 1013116383 |
---|---|
Provider Name | Dr. Nicholas James Kelsey |
First Address | Twin Falls, ID 83301-3382 |
Second Address | Twin Falls, ID 83301-3382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 16/07/2007 |