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General NPI Number Information
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NPI Number | 1669587143
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Entity Type | Individual
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Provider Name | KELLI BISHOP O.D
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 1529 380 BYP
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City | GRAHAM
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State | TX
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Zip | 76450-2323
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Country | US
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Telephone | 940-549-1621
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Fax |
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Provider Business Mailing Address
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Address Line | 907 BRAZOS ST
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City | GRAHAM
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State | TX
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Zip | 76450-3905
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Country | US
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Telephone | 940-521-8552
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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 | 1683DT
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License Number State | KY
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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 | 8043T
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License Number State | TX
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