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General NPI Number Information
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NPI Number | 1265607675
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Entity Type | Organization
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Legal Business Name | DR.NORWOOD R. KELLY JR.APOC
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 2010 WOODMERE BLVD SUITE H
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City | HARVEY
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State | LA
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Zip | 70058-2286
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Country | US
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Telephone | 504-452-0390
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Fax |
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Provider Business Mailing Address
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Address Line | 242 SARAH VICTORIA DR
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City | BELLE CHASSE
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State | LA
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Zip | 70037-4146
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Country | US
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Telephone | 504-452-0390
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NORWOOD R KELLY JR.
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Credential | O.D.
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Telephone | 504-452-0390
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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 | 939-165T
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License Number State | LA
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