Provider Demographics
NPI:1336590116
Name:SIEG, KELSEY MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:MARIE
Last Name:SIEG
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 1:817 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2506
Mailing Address - Country:US
Mailing Address - Phone:612-488-1566
Mailing Address - Fax:612-488-1564
Practice Address - Street 1:817 E 66TH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2506
Practice Address - Country:US
Practice Address - Phone:612-488-1566
Practice Address - Fax:612-488-1564
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60663734152W00000X, 152WP0200X, 152WV0400X
MN3592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy