Provider Demographics
NPI:1275622037
Name:MARGENA KELTNER OD PSC
Entity Type:Organization
Organization Name:MARGENA KELTNER OD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGENA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KELTNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-849-3434
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456
Mailing Address - Country:US
Mailing Address - Phone:606-256-3937
Mailing Address - Fax:
Practice Address - Street 1:205 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456
Practice Address - Country:US
Practice Address - Phone:606-256-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000362Medicaid
U87729Medicare UPIN
KY9854Medicare PIN
KY0985401Medicare PIN