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General NPI Number Information
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NPI Number | 1396979944
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Entity Type | Individual
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Provider Name | KELLY DUFF VISENTINE O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 3551 JUSTIN RD STE 150
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City | FLOWER MOUND
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State | TX
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Zip | 75028-6213
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Country | US
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Telephone | 972-355-5152
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Fax | 972-691-2958
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Provider Business Mailing Address
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Address Line | 3106 WOODHOLLOW DR
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City | FLOWER MOUND
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State | TX
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Zip | 75022-8475
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Country | US
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Telephone | 972-259-0052
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Fax |
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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 | 4924TG
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License Number State | TX
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