Healthcare Provider Details

I. General information

NPI: 1598740367
Provider Name (Legal Business Name): KELBY ATKINS TRUSTY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 UNICORN LAKE BLVD STE 100
DENTON TX
76210-0117
US

IV. Provider business mailing address

3111 UNICORN LAKE BLVD STE 100
DENTON TX
76210-0118
US

V. Phone/Fax

Practice location:
  • Phone: 940-891-3937
  • Fax: 940-591-8368
Mailing address:
  • Phone: 940-891-3937
  • Fax: 940-591-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3995TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number3995TG
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3995TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: