Provider Demographics
NPI:1518174341
Name:KELSEY, DOUGLAS A (ABOC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:A
Last Name:KELSEY
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 E IRON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3284
Mailing Address - Country:US
Mailing Address - Phone:785-827-8123
Mailing Address - Fax:785-827-0051
Practice Address - Street 1:1410 E IRON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3284
Practice Address - Country:US
Practice Address - Phone:785-827-8123
Practice Address - Fax:785-827-0051
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS021301156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1149850001Medicare ID - Type Unspecified