Healthcare Provider Details

I. General information

NPI: 1568385110
Provider Name (Legal Business Name): KELLI POPPAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHAMBER DR
MILFORD OH
45150-2516
US

IV. Provider business mailing address

493 GLENROSE LN
CINCINNATI OH
45244-2238
US

V. Phone/Fax

Practice location:
  • Phone: 513-248-4291
  • Fax: 513-248-4269
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: