Provider Demographics
NPI:1598781759
Name:NORLAND, KELLY (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:NORLAND
Suffix:
Gender:M
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:PO BOX AG
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-0328
Mailing Address - Country:US
Mailing Address - Phone:712-336-1960
Mailing Address - Fax:712-336-5428
Practice Address - Street 1:2312 23RD ST
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1044
Practice Address - Country:US
Practice Address - Phone:712-336-1960
Practice Address - Fax:712-336-5428
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01903152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0286104Medicaid
IA28610OtherWELLMARK BCBS OF IOWA
IAT86934Medicare UPIN
IA28610Medicare ID - Type Unspecified
IA0343680002Medicare NSC