Provider Demographics
NPI:1215249719
Name:BELL, KELSEY K (OD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:K
Last Name:BELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2878 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-8094
Mailing Address - Country:US
Mailing Address - Phone:574-935-3937
Mailing Address - Fax:574-936-4942
Practice Address - Street 1:2878 MILLER DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8094
Practice Address - Country:US
Practice Address - Phone:574-935-3937
Practice Address - Fax:574-936-4942
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003635A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000676765OtherANTHEM
INAO5001OtherEYEMED
IN200988340Medicaid
IN200988340Medicaid