Healthcare Provider Details

I. General information

NPI: 1891145900
Provider Name (Legal Business Name): KELSEY BERTRIE EVANS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 CHAD DR
EUGENE OR
97408-7336
US

IV. Provider business mailing address

2828 CHAD DR
EUGENE OR
97408-7336
US

V. Phone/Fax

Practice location:
  • Phone: 541-242-0789
  • Fax: 541-242-0787
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3665ATI
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: