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General NPI Number Information
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NPI Number | 1164572970
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Entity Type | Individual
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Provider Name | KELLY D. DESIMONE O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 15725 SOUTH 46TH ST SUITE 112
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City | PHOENIX
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State | AZ
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Zip | 85048
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Country | US
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Telephone | 480-893-2300
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Fax | 480-893-0522
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Provider Business Mailing Address
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Address Line | 14417 S 24TH PL
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City | PHOENIX
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State | AZ
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Zip | 85048-9015
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Country | US
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Telephone | 480-759-0314
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Fax | 480-759-0863
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0862
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 0862
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License Number State | AZ
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