Provider Demographics
NPI:1700163839
Name:NICHOLAS J KELSEY
Entity Type:Organization
Organization Name:NICHOLAS J KELSEY
Other - Org Name:CLARITY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIS
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-731-8974
Mailing Address - Street 1:928 TROTTER DR.
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:503 BROADWAY AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-1312
Practice Address - Country:US
Practice Address - Phone:208-944-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100146152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty