MEDICARE: DR. NANCY LYNN KELSO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OP3160	FL

General Provider Information

NPI Number	:	1356371934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY LYNN KELSO O.D.

Provider Business Mailing Address
First Line	:	1137 ISLAND RD
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-4707
Country	:	US
Telephone Number	:	561-848-3171
Fax Number	:	561-745-5409

Provider Business Practice Location Address
First Line	:	1872 N MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4716
Country	:	US
Telephone Number	:	561-296-2020
Fax Number	:	561-242-0191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/26/2008

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