Provider Demographics
NPI:1568037554
Name:SIEPS, KELLY JO (OD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:SIEPS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:201 E 4TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-9916
Mailing Address - Country:US
Mailing Address - Phone:531-625-3941
Mailing Address - Fax:
Practice Address - Street 1:201 E 4TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-9916
Practice Address - Country:US
Practice Address - Phone:531-625-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-23
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY2247DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist