Provider Demographics
NPI:1477250900
Name:KELSO, BRITTNEY KAY
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:KAY
Last Name:KELSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3090
Mailing Address - Country:US
Mailing Address - Phone:740-364-9130
Mailing Address - Fax:740-364-9159
Practice Address - Street 1:1315 N 21ST ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3090
Practice Address - Country:US
Practice Address - Phone:740-364-9130
Practice Address - Fax:740-364-9159
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.017325-SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician