Provider Demographics
NPI:1659729580
Name:KOERNER, KELSEY B (OD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:B
Last Name:KOERNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:B
Other - Last Name:NUERNBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1935 EVA RD APT 46
Mailing Address - Street 2:
Mailing Address - City:KRONENWETTER
Mailing Address - State:WI
Mailing Address - Zip Code:54455-7114
Mailing Address - Country:US
Mailing Address - Phone:715-965-2943
Mailing Address - Fax:
Practice Address - Street 1:205 W BRIDGE ST STE 101
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3000
Practice Address - Country:US
Practice Address - Phone:715-848-2020
Practice Address - Fax:715-845-6669
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3408-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist