Individual
DR. KELSEY MARIE MANESCALCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
15704 90TH ST NE # 100, OTSEGO, MN 55330-7448
(763) 241-1090
Mailing address
15704 90TH ST NE # 100, OTSEGO, MN 55330-7448
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3513
MN
152WP0200X
Pediatric Optometrist
3513
MN
152WS0006X
Sports Vision Optometrist
3513
MN
152WV0400X
Vision Therapy Optometrist
3513
MN
Other
Enumeration date
07/10/2017
Last updated
07/10/2017
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