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General NPI Number Information
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NPI Number | 1396058962
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Entity Type | Individual
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Provider Name | KELLY LU O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 3700 E STATE HIGHWAY 18
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-6881
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Country | US
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Telephone | 870-762-0711
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Fax | 870-762-4139
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Provider Business Mailing Address
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Address Line | 3700 E STATE HIGHWAY 18
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-6881
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Country | US
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Telephone | 870-762-0711
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Fax | 870-762-4139
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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 | 2653
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License Number State | AR
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