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General NPI Number Information
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NPI Number | 1528100419
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Entity Type | Individual
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Provider Name | THOMAS R KELLEY O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 5800 PEACH ST
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City | ERIE
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State | PA
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Zip | 16565-1601
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Country | US
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Telephone | 814-864-2020
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Fax | 814-868-8534
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Provider Business Mailing Address
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Address Line | 1105 SAINT MARY DR
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City | ERIE
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State | PA
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Zip | 16509-2975
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Country | US
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Telephone | 814-866-5599
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Fax | 814-866-5599
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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 | OEG001407
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License Number State | PA
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