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Individual

JESSICA KELLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
4401 COLEMAN ST STE 102, BISMARCK, ND 58503-1371
(701) 390-1315
Mailing address
4401 COLEMAN ST STE 102, BISMARCK, ND 58503-1371
(701) 390-1315

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
710
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
710
STATE LICENSE
ND
Enumeration date
10/06/2010
Last updated
07/21/2022
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