=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710433420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEEK EYE CARE, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2016
-----------------------------------------------------
Last Update Date | 04/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7940 VICTORIA DRIVE SUITE 103
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-325-4544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55386-0011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-800-7335
-----------------------------------------------------
Fax | 612-800-7336
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPTOMETRIST
-----------------------------------------------------
Name | DR. KELSEY M KELTGEN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 812-325-4544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3237
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------