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General NPI Number Information
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NPI Number | 1194163881
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Entity Type | Individual
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Provider Name | KELSEY ANN JANCARO O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 1000 ROSS PARK MALL DR
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City | PITTSBURGH
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State | PA
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Zip | 15237-3875
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Country | US
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Telephone | 412-364-6478
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 9TH AVE
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City | BRACKENRIDGE
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State | PA
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Zip | 15014-1301
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Country | US
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Telephone | 814-243-4846
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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 | OEG002751
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License Number State | PA
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