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General NPI Number Information
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NPI Number | 1447632187
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Entity Type | Individual
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Provider Name | KELLY ANN DURST-SHARPE O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1125 HAMPSHIRE ST
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City | QUINCY
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State | IL
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Zip | 62301-3026
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Country | US
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Telephone | 217-222-6550
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Fax | 217-277-2253
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Provider Business Mailing Address
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Address Line | 1025 MAINE ST
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City | QUINCY
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State | IL
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Zip | 62301-4038
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Country | US
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Telephone | 217-222-6550
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Fax | 217-277-2253
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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 | 2015019033
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046011066
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License Number State | IL
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