Individual provider · NPI-1

Kelly Lyn Chasnov

Technician/Technologist, Optician · Fort Myers, FL

NPI number1487153391
StatusActive
Last updated in NPPESFeb 6, 2018

Details

NPI
1487153391
Entity type
Individual (NPI-1)
Name
Kelly Lyn Chasnov
Sex
Female
Sole proprietor
No
Enumeration date
Feb 6, 2018
Last updated
Feb 6, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
156FX1800X Technician/Technologist, Optician4828FLYes

Practice location

15245 S Tamiami Trl Ste 6
Fort Myers, FL 33908-4596

Phone 239-405-0346

Mailing address

15245 S Tamiami Trl Ste 6
Fort Myers, FL 33908-4596

Phone 239-405-0346

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