Most Relevant Information
Provider Data
| NPI Number: | 1003338211 |
| Provider Name: | KELSEY MARIE MANESCALCO OD |
| Entity Type: | Individual |
| Taxonomy Code: | 152WP0200X |
| Specialty: | Optometrist |
| License Number: | 3513 |
Most Important Dates
| Enumeration Date: | 07/10/2017 |
| Last Updated: | 07/10/2017 |
Provider Practice Location
15704 90TH ST NE # 100
OTSEGO
MN
553307448
Practice Location Phone/Fax
| Phone: | 7632411090 |
| Fax: |
Provider Mailing Location
15704 90TH ST NE # 100
OTSEGO
MN
553307448
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |