Provider Demographics
NPI:1467075929
Name:ENGELMAN, KELSEY TRICIA (OD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:TRICIA
Last Name:ENGELMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KELSEY
Other - Middle Name:TRICIA
Other - Last Name:BINGGELI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4499 TOWN CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3425
Mailing Address - Country:US
Mailing Address - Phone:810-733-7111
Mailing Address - Fax:
Practice Address - Street 1:4499 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3425
Practice Address - Country:US
Practice Address - Phone:810-733-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist