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General NPI Number Information
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NPI Number | 1093915514
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Entity Type | Individual
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Provider Name | KELSEY ANN CANNON O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 2100 VISTA WAY
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City | OCEANSIDE
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State | CA
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Zip | 92054-5600
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Country | US
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Telephone | 760-439-7413
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Fax | 760-439-8271
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Provider Business Mailing Address
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Address Line | 12950 CARMEL CREEK RD UNIT 103
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City | SAN DIEGO
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State | CA
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Zip | 92130-2130
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Country | US
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Telephone | 714-745-1095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 13291
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License Number State | CA
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