Healthcare Provider Details

I. General information

NPI: 1104435007
Provider Name (Legal Business Name): KELSIE R SOMMERFELD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 CRAIG RD
EAU CLAIRE WI
54701-6149
US

IV. Provider business mailing address

2116 CRAIG RD
EAU CLAIRE WI
54701-6149
US

V. Phone/Fax

Practice location:
  • Phone: 715-858-4500
  • Fax: 715-858-4509
Mailing address:
  • Phone: 715-858-4500
  • Fax: 715-858-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3634-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: