=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023294402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN J. KELLEY ASSOC., LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2008
-----------------------------------------------------
Last Update Date | 01/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1528 WALNUT ST SUITE 1801
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-3604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-545-0939
-----------------------------------------------------
Fax | 215-545-0938
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1528 WALNUT ST SUITE 1801
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-3604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-545-0939
-----------------------------------------------------
Fax | 215-545-0938
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PREDSIDENT
-----------------------------------------------------
Name | MR. KEVIN V. KELLEY
-----------------------------------------------------
Credential | BCO
-----------------------------------------------------
Telephone | 215-545-0939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1700X
-----------------------------------------------------
Taxonomy Name | Ocularist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------