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General NPI Number Information
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NPI Number | 1043591159
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Entity Type | Organization
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Legal Business Name | KELLEE N. BERTSCH, OD, LIMITED, PA
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 6730 ATASCOCITA RD SUITE 101
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City | HUMBLE
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State | TX
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Zip | 77346-1993
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Country | US
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Telephone | 281-451-2838
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Fax | 281-852-8146
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Provider Business Mailing Address
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Address Line | 6730 ATASCOCITA ROAD SUITE 101
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City | HUMBLE
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State | TX
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Zip | 77346
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Country | US
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Telephone | 281-451-2838
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Fax | 281-852-8146
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. KELLEE N BERTSCH
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Credential | O.D.
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Telephone | 281-451-2838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5891TG
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License Number State | TX
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