Provider Demographics
NPI:1528238581
Name:KELTNER, MARGENA LYNN (OD)
Entity type:Individual
Prefix:
First Name:MARGENA
Middle Name:LYNN
Last Name:KELTNER
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 1:68 WELLNESS LN
Mailing Address - Street 2:205 RICHMOND ST
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-7650
Mailing Address - Country:US
Mailing Address - Phone:606-256-3937
Mailing Address - Fax:
Practice Address - Street 1:68 WELLNESS LN
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-7650
Practice Address - Country:US
Practice Address - Phone:270-469-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1521DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000362Medicaid
U87729Medicare UPIN
KY77000362Medicaid