MEDICARE: KELSEY MARIE KELTGEN 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	3237	MN
2	152W00000X	Optometrist	0003237	MN

General Provider Information

NPI Number	:	1609156835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY MARIE KELTGEN O.D.

Provider Business Mailing Address
First Line	:	2160 ARBORETUM BLVD
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-3300
Country	:	US
Telephone Number	:	612-800-7335
Fax Number	:	612-800-7336

Provider Business Practice Location Address
First Line	:	2160 ARBORETUM BLVD
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-3300
Country	:	US
Telephone Number	:	612-800-7335
Fax Number	:	612-800-7336

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

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	04/15/2025

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