MEDICARE: KELLEE N BERTSCH OD

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	05891TG	TX

General Provider Information

NPI Number	:	1437230117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEE N BERTSCH OD

Provider Business Mailing Address
First Line	:	18915 ATASCOCITA FOREST DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-5125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6970 FM 1960 RD W
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77069-3719
Country	:	US
Telephone Number	:	281-469-2020
Fax Number	:	281-469-7531

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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Directions to “ KELLEE N BERTSCH OD” Practice Location

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