Healthcare Provider Details

I. General information

NPI: 1275622037
Provider Name (Legal Business Name): MARGENA KELTNER OD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 RICHMOND ST
MT VERNON KY
40456
US

IV. Provider business mailing address

PO BOX 1050
MT VERNON KY
40456
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-3937
  • Fax:
Mailing address:
  • Phone: 606-256-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARGENA LYNN KELTNER
Title or Position: PRESIDENT
Credential: OD
Phone: 270-849-3434