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General NPI Number Information
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NPI Number | 1992188114
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Entity Type | Individual
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Provider Name | KELSEY DEITZ GUTH O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 5215 MONTICELLO AVE STE A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-8232
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Country | US
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Telephone | 757-229-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 45923
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City | BALTIMORE
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State | MD
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Zip | 21297-5923
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Country | US
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Telephone | 434-661-7762
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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 | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 0618002488
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License Number State | VA
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