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General NPI Number Information
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NPI Number | 1598781759
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Entity Type | Individual
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Provider Name | KELLY NORLAND OD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 2312 23RD ST
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City | SPIRIT LAKE
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State | IA
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Zip | 51360-1044
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Country | US
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Telephone | 712-336-1960
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Fax | 712-336-5428
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Provider Business Mailing Address
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Address Line | PO BOX AG
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City | SPIRIT LAKE
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State | IA
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Zip | 51360-0328
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Country | US
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Telephone | 712-336-1960
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Fax | 712-336-5428
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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 | 01903
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License Number State | IA
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