Provider Demographics
NPI:1780033217
Name:NAYLOR, KELSEA DIANE (OD)
Entity Type:Individual
Prefix:DR
First Name:KELSEA
Middle Name:DIANE
Last Name:NAYLOR
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 1:113 N LISBON ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-1327
Mailing Address - Country:US
Mailing Address - Phone:330-627-2430
Mailing Address - Fax:330-627-5681
Practice Address - Street 1:113 N LISBON ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1327
Practice Address - Country:US
Practice Address - Phone:330-627-2430
Practice Address - Fax:330-627-5681
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0171174Medicaid