Provider Demographics
NPI:1831145010
Name:MELISSA R KEUSLER, OD, PA
Entity Type:Organization
Organization Name:MELISSA R KEUSLER, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEUSLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-260-8788
Mailing Address - Street 1:6110 W KELLOGG DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2361
Mailing Address - Country:US
Mailing Address - Phone:316-260-8788
Mailing Address - Fax:316-943-8787
Practice Address - Street 1:6110 W KELLOGG DR
Practice Address - Street 2:SUITE #1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2361
Practice Address - Country:US
Practice Address - Phone:316-260-8788
Practice Address - Fax:316-943-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1465-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS065089Medicare ID - Type UnspecifiedGROUP NUMBER