Provider Demographics
NPI:1356371934
Name:KELSO, NANCY LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LYNN
Last Name:KELSO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1137 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-4707
Mailing Address - Country:US
Mailing Address - Phone:561-848-3171
Mailing Address - Fax:561-745-5409
Practice Address - Street 1:1872 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4716
Practice Address - Country:US
Practice Address - Phone:561-296-2020
Practice Address - Fax:561-242-0191
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP3160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU811320001Medicare UPIN