Provider Demographics
NPI:1316913080
Name:KEUSLER, MELISSA RAMOS (OD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:RAMOS
Last Name:KEUSLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6110 W KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2361
Mailing Address - Country:US
Mailing Address - Phone:316-260-8788
Mailing Address - Fax:316-943-8787
Practice Address - Street 1:6110 W KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2361
Practice Address - Country:US
Practice Address - Phone:316-260-8788
Practice Address - Fax:316-943-8787
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1011220510CMedicaid
KS1011220510CMedicaid
KSU57072Medicare UPIN