Healthcare Provider Details

I. General information

NPI: 1992363303
Provider Name (Legal Business Name): KELLY ELIZABETH MORGESE OD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 HARPER DR NE
ALBUQUERQUE NM
87109-3566
US

IV. Provider business mailing address

8801 HORIZON BLVD NE STE 360
ALBUQUERQUE NM
87113-1563
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-5757
  • Fax:
Mailing address:
  • Phone: 505-615-4964
  • Fax: 505-213-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0716
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: