Provider Demographics
NPI:1477840478
Name:NEBELSICK, KERI DANAE (OD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:DANAE
Last Name:NEBELSICK
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 1:211 E HAVENS AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-4402
Mailing Address - Country:US
Mailing Address - Phone:605-995-5640
Mailing Address - Fax:605-996-4671
Practice Address - Street 1:211 E HAVENS AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4402
Practice Address - Country:US
Practice Address - Phone:605-995-5640
Practice Address - Fax:605-996-4671
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3287152W00000X
IN18003680A152W00000X, 152WP0200X
WI3261-35152W00000X
SD703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics