MEDICARE: DR. SARAH LEIGH KELLEY O.D.

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	1983	KS

General Provider Information

NPI Number	:	1710395769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH LEIGH KELLEY O.D.

Provider Business Mailing Address
First Line	:	115 W LAUREL ST
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-3311
Country	:	US
Telephone Number	:	620-331-9090
Fax Number	:	620-331-0011

Provider Business Practice Location Address
First Line	:	115 W LAUREL ST
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-3311
Country	:	US
Telephone Number	:	620-331-9090
Fax Number	:	620-331-0011

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

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	09/25/2023

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