MEDICARE: DR. KELSEY H JEWETT 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	5883T	CA

General Provider Information

NPI Number	:	1396880415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELSEY H JEWETT O.D.

Provider Business Mailing Address
First Line	:	4767 ROCKY RIDGE CT
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-4005
Country	:	US
Telephone Number	:	530-209-3315
Fax Number	:

Provider Business Practice Location Address
First Line	:	4626 SHASTA DAM BLVD
Second Line	:
City	:	SHASTA LAKE
State	:	CA
Zip	:	96019-9414
Country	:	US
Telephone Number	:	530-275-0866
Fax Number	:

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	12/12/2025

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