Provider Demographics
NPI:1326711334
Name:HARNISH, KELSEY (OD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HARNISH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWMANSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17073-9113
Mailing Address - Country:US
Mailing Address - Phone:610-763-5843
Mailing Address - Fax:
Practice Address - Street 1:605 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067-2332
Practice Address - Country:US
Practice Address - Phone:717-866-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003826152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist