Provider Demographics
NPI:1659353522
Name:KELTNER, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:KELTNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:OPHTH & VISION SCI STE 2400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-6310
Mailing Address - Fax:916-734-6197
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:OPHTH & VISION SCI STE 2400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6310
Practice Address - Fax:916-734-6197
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG15710207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR002104IMedicaid
CAA39598Medicare UPIN
CAZZZP3420ZMedicare ID - Type Unspecified