Provider Demographics
NPI:1730498817
Name:ROLFSTAD, KELCI KAY (OD)
Entity Type:Individual
Prefix:MRS
First Name:KELCI
Middle Name:KAY
Last Name:ROLFSTAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LAKE ELMO DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3066
Mailing Address - Country:US
Mailing Address - Phone:406-252-9927
Mailing Address - Fax:
Practice Address - Street 1:430 LAKE ELMO DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3066
Practice Address - Country:US
Practice Address - Phone:406-252-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOPT-OPT-LIC-1845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist