MEDICARE: KELLY NEIDIFFER BAILEY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18003232A	IN
2	152W00000X	Optometrist	1594 DT	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00191799	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000350868	OTHER	IN	ANTHEM BCBS
2	18003232A	OTHER	IN	OD LICENSE NUMBER
3	1594DT	OTHER	KY	OD LICENSE NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225020365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY NEIDIFFER BAILEY OD

Provider Business Mailing Address
First Line	:	4326 CHARLESTOWN RD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-9568
Country	:	US
Telephone Number	:	812-945-0023
Fax Number	:	812-945-0291

Provider Business Practice Location Address
First Line	:	4326 CHARLESTOWN RD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-9568
Country	:	US
Telephone Number	:	812-945-0023
Fax Number	:	812-945-0291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	09/25/2012

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Directions to “ KELLY NEIDIFFER BAILEY OD” Practice Location

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