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General NPI Number Information
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NPI Number | 1912933250
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Entity Type | Individual
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Provider Name | TRAVIS JACOBS KELSO O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6230 W INDIANTOWN RD
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City | JUPITER
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State | FL
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Zip | 33458-7917
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Country | US
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Telephone | 561-743-2020
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Fax | 561-745-5409
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Provider Business Mailing Address
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Address Line | 1137 ISLAND RD
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-4707
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Country | US
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Telephone | 561-848-3171
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Fax | 561-745-5409
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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 | OP3360
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License Number State | FL
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