Healthcare Provider Details

I. General information

NPI: 1356371934
Provider Name (Legal Business Name): NANCY LYNN KELSO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W INDIANTOWN RD
JUPITER FL
33458-3924
US

IV. Provider business mailing address

2205 W INDIANTOWN RD
JUPITER FL
33458-3924
US

V. Phone/Fax

Practice location:
  • Phone: 561-296-2020
  • Fax: 561-407-6107
Mailing address:
  • Phone: 561-743-2020
  • Fax: 561-407-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP3160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: