Healthcare Provider Details

I. General information

NPI: 1366472177
Provider Name (Legal Business Name): THE KELLY EYE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 ELLSTREE LN SUITE 200
RALEIGH NC
27617-2045
US

IV. Provider business mailing address

8851 ELLSTREE LN SUITE 200
RALEIGH NC
27617-2045
US

V. Phone/Fax

Practice location:
  • Phone: 919-282-1100
  • Fax: 919-282-1119
Mailing address:
  • Phone: 919-282-1100
  • Fax: 919-282-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL WALKER KELLY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 919-282-1100