Provider Demographics
NPI:1023492741
Name:MILESKI, KELSEY MOODY (OD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MOODY
Last Name:MILESKI
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 1:3316 3RD ST S STE 103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6090
Mailing Address - Country:US
Mailing Address - Phone:904-241-7865
Mailing Address - Fax:
Practice Address - Street 1:3316 3RD ST S STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-6090
Practice Address - Country:US
Practice Address - Phone:904-241-7865
Practice Address - Fax:904-249-2352
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003028152W00000X
GAOPT003078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13584689OtherCAQH NUMBER