Individual
DR. KELLY K FRISELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
149 ORIOLE DR, LAKE OZARK, MO 65049-5608
(618) 410-5588
Mailing address
149 ORIOLE DR, LAKE OZARK, MO 65049-5608
(618) 410-5588
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2008034213
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410049863
RAILROAD MEDICARE
IL
Enumeration date
07/10/2006
Last updated
06/29/2022
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